INTRODUCTION During my pediatrics residency training in the early 1990s, I helped care for Grace, a three-year-old girl who was admitted to the hospital with failure to thrive. This condition — usually caused by a chronic medical problem, improper nutrition, or neglect — results in poor weight gain and stunted growth. However, Grace’s condition was unusual: she had gained no weight at all in nine months, but her growth had continued at an entirely normal rate. In addition, her appearance was striking, especially compared to photos taken of her in infancy. Over the previous year, all of her normal baby fat had melted away, yet her muscles were remarkably preserved, making her look like a tiny bodybuilder.
After a few days of fruitless investigation, we finally discovered that Grace had a rare abnormality in a region of the brain called the hypothalamus, which controls body weight. Somehow her brain was sending her body the message to shed every single ounce of fat. But since she was otherwise healthy, the growth of other body tissues continued uninterrupted. Unfortunately, the surgery needed to treat Grace’s condition produced damage to the part of the brain that controls satiety, the sensation of fullness we get after eating. Almost immediately after recovering from surgery, Grace developed a ravenous appetite and a significant problem with overeating. Through the next few years, Grace gained a great deal of weight, going from being substantially underweight to seriously overweight. Grace’s mother, with support from our medical team, struggled to control her daughter’s hunger and slow down her weight gain.
By the end of my pediatrics training, the obesity epidemic in the United States was in full swing. Influenced in part by my experience with Grace, I decided to pursue a career in obesity and joined a basic research laboratory studying the biological factors that affect body weight. I became fascinated by the beauty and complexity of the body’s weight-regulating systems. Under most circumstances, these systems help maintain a near- perfect balance between calorie intake and calorie expenditure. Without these systems, our weight would fluctuate wildly, as did Grace’s. Just the calories in an extra bagel and cream cheese each day could cause a thirty- five-pound weight gain in one year.
During my five years in basic research, I helped discover a gene that can make laboratory mice fat and might contribute to human obesity. However, I came to believe that the discovery of new genes was unlikely to provide a cure for obesity anytime soon. After all, our genes haven’t changed much in the past thirty years, but rates of obesity have more than doubled. So in 1996, I left the basic laboratory, began researching new dietary approaches to obesity in people, and developed the Optimal Weight for Life (OWL) Program at Children’s Hospital Boston. Since then, OWL has grown from a staff of two to one of the largest clinics for overweight children and their families in the country.
When people find out what kind of work I do, they often say something like, “You treat overweight children? That must be so sad.” Sometimes I do feel sad. Overweight people, and especially children, are subject to incessant teasing, abuse, and discrimination. The stories of our patients can at times be heartbreaking. And sometimes I feel angry. Soft drink companies spend millions of dollars on advertising targeting children, but OWL has to fight with insurance companies for only a few hundred dollars to cover the treatment of an obese child. More often I feel joy. In addition to the small, day-to-day victories that you’ll read about throughout this book, there are great triumphs. For instance, in chapter 2 you’ll meet Michael, who came to OWL at age fourteen. At that time, he was 5 feet 4 inches tall and weighed 220 pounds; he had high cholesterol, high triglycerides, fatty liver, and insulin resistance. Now nineteen years old and 5 feet 10 inches tall, Michael has reached an optimal weight of 155 pounds, and all of his obesity- related complications have resolved.
If you are the parent of an overweight child, or if you want to prevent a problem from developing in the future, this book is for you. In the following pages, I’ll share with you what we’ve learned from fifteen years of research and from working with thousands of families just like yours. I’ll introduce you to OWL patients who have made dramatic breakthroughs and others who are still struggling. And I’ll walk with you, step by step, as you and your family take this journey to health.
Copyright © 2007 by David Ludwig. Reprinted by permission of Houghton Mifflin Company.