HOW’S THIS for an unlikely weapon against obesity: On 10-year-old Ezra Fellman-Blau’s first visit to the child-obesity clinic at Children’s Hospital, Dr. David Ludwig offers the boy a piece of chocolate.
It’s dark chocolate, specifically — the rich, bitter stuff — and Ludwig first explains that, unlike milk chocolate, this is a health food. Then he gives Ezra a lesson in how to eat. Smell your food. Then lick it. Then chew it slowly. Swallow. Take note of every sensation, in your mouth and in your stomach.
It’s an experiment in what Ludwig calls “mindful eating,’’ and it highlights one of the many ways our relationship with food has been distorted. “We’re taught to eat things unconsciously,’’ he says. We gobble down foods that are salty or sweet, shy away from complex flavors, label some foods that are good for us as unhealthy, and vice versa. We think that counting calories and vilifying fat will help us get thin.
When it comes to fighting childhood obesity, “I don’t think food is the problem,’’ Ludwig said. “I think food is the answer.’’
The problem, it turns, out, is much harder to address.
And the problem is growing, nationwide and close to home. Today, one-third of Massachusetts children are overweight or obese, according to a recent report from the Boston Foundation and the New England Healthcare Institute. In 2009, nearly half of the state’s public school students attended no gym classes at all.
The health implications are pressing, and so are the costs: Phil Edmundson, a Boston insurance company chief who is spearheading his own anti-obesity campaign, notes that obesity-related illnesses account for nearly a third of the increase in health care costs. At Ludwig’s clinic — known as OWL, for Optimal Weight for Life — many patients are at risk of diabetes, heart disease, and other chronic illnesses that could lead to premature death.
There is, at least, a growing awareness of the problem among public policy workers and philanthropists. The bad news is that change isn’t just a matter of awareness, or even good intentions. It will require cutting through a whole host of cultural messages, social pressures, and financial incentives to eat unhealthily. As Ludwig’s chocolate experiment shows, our relationship with food is topsy-turvy, and it’s easy to make mistakes.
Ezra is a case in point. Like most OWL patients, he has a body-mass index above the 95th percentile for his age. But he’s not the stereotypical kid with obesity, gouging on McDonald’s every day while parked in front of SpongeBob. His family is trying hard to do everything right, and then some: No fast food, no TV in the home. Mom cooks most meals, vegetarian. Ezra plays soccer a few times a week.
So Ludwig asks Ezra and his mother to go through his daily diet. What does he have for breakfast? A cup or a cup and a half of cereal — Cheerios, Rice Krispies, or the like — with soy milk. For a snack? Sometimes a yogurt. For dinner? Often, pasta.
That’s when Ludwig breaks the news: A lot of that is harmful, too. Ezra is eating a double-serving of cereal, for instance; processed carbohydrates are going off “like a sugar bomb’’ in his stomach, Ludwig says. You could eat a bowlful of corn flakes with no sugar, he explains, or you could eat a bowlful of sugar with no cornflakes. Once you swallow it down, there’s little nutritional difference.
Snacks like yogurt, likewise, are often more sugar than sustenance. (One of Ezra’s favorite yogurt flavors, it turns out, is Boston Cream Pie.) Pasta is another processed carbohydrate, the sort of food that will make Ezra hungrier in the short term and heavier in the long term.
We think of eating habits as something adults — and maybe even children — should learn to control through force of will. And yes, personal responsibility is an important component of good health. But that’s easier said than done. When people talk about the fight against child obesity, they often use smoking as an analogy: With time, effort, and brilliant PR, our culture has largely managed to make cigarettes seem unhealthy, unappealing. (And tobacco companies have turned to markets in Asia, where that transformation hasn’t happened yet.)
But while it’s easy to simply label smoking bad, it’s much harder to change habits about food. Especially when much of what we’ve been taught, or been conditioned to believe, about healthy eating turns out to be untrue, or painfully distorted.
That old food pyramid that today’s parents grew up with, with the carbohydrates on the bottom floor? Basically wrong. The obsession with fat and calories as a measure of healthy eating? Also wrong. At OWL intake meetings, the subject of calories seldom comes up. But sometimes Ludwig has to explain why avocados are hugely healthy, even if they’re high in fat.
And he knows that people are trolling the supermarket aisles and buying up those 100-calorie snack packs - paying more for less-filling food that will only make them hungrier before the next meal. He calls those little packs “one of the most brilliant and harmful marketing devices ever created.’’
Even people who are armed with good information often go awry, or face unexpected obstacles. Later in the day at OWL, Ezra and his mother move on to a meeting with staff psychologist Lori Parras. (OWL patients start by seeing a physician, a behaviorist, and a nutritionist, a sign that obesity has to be addressed on many levels.) She explains that the very layout of modern homes can make it harder to fight obesity; kitchens are often at the center of the floor plan, and if they’re stocked with the wrong foods, the temptation to eat badly can be even greater.
After Ezra goes home , Ludwig sees another family that is struggling to do right against competing incentives. The dad understands that sugary soft drinks are bad for his overweight son. But he keeps getting coupons to buy them in bulk. And he’s finding it hard to resist the good deals.
Ludwig has a wish list of broad public policy goals that he says would help parents to make the right choices. He wants to regulate food advertising to children. (“Why should we undermine parental responsibility with a multimillion-dollar marketing campaign?’’ he says.) He wants to eliminate federal subsidies for low-quality foods — wheat, rice, soybeans for cattle feed — and invest that money in good fruits, vegetables, and grains.
He also advocates funding schools properly to provide nutritious food and suitable exercise. Right now, Massachusetts doesn’t require any physical education in high schools. And in times of Draconian budget cuts, gym classes are often among the first things to go.
Some of these steps seem pie-in-the sky. Some seem achievable, given the right public will. A bill in the Legislature, filed by Representative Jeffrey Sanchez of Jamaica Plain, would mandate at least 30 minutes of physical education for all public school students, every day.
And local activists are also pressing for a bill that would eliminate the sales tax exemption on sugar-sweetened beverages. In the past, Governor Deval Patrick has introduced similar measures, which went nowhere. This year, Representative Kay Khan of Newton is leading the fight.
As before, the bill will likely run up against the lobbying efforts of the beverage industry, along with the tried-and-true arguments about how taxes are too high and willpower is too low. To which there are several answers. First of all, this isn’t imposing a tax. It’s cutting a tax break on something bad for us — and, if anything, that break should be rescinded for other types of junk food, too. Second, personal responsibility is tougher to maintain when food labels are shouting out misleading claims in the supermarket aisles.
Fighting childhood obesity is an uphill battle against a lot of assumptions. If someone came up to you on a street corner and told you that chocolate could help you lose weight, would you believe him?