Showing papers by "David S. Ludwig published in 2010"

Personal Responsibility And Obesity: A Constructive Approach To A Controversial Issue

Abstract: The concept of personal responsibility has been central to social, legal, and political approaches to obesity. It evokes language of blame, weakness, and vice and is a leading basis for inadequate government efforts, given the importance of environmental conditions in explaining high rates of obesity. These environmental conditions can override individual physical and psychological regulatory systems that might otherwise stand in the way of weight gain and obesity, hence undermining personal responsibility, narrowing choices, and eroding personal freedoms. Personal responsibility can be embraced as a value by placing priority on legislative and regulatory actions such as improving school nutrition, menu labeling, altering industry marketing practices, and even such controversial measures as the use of food taxes that create healthier defaults, thus supporting responsible behavior and bridging the divide between views based on individualistic versus collective responsibility.

Dietary guidelines in the 21st century--a time for food.

Abstract: THE DISCOVERY OF SPECIFIC DIETARY INSUFFICIENCIES as the cause of human disease played a central role in the development of modern nutritional science. In 1753, one of the first clinical trials showed that citrus fruit could prevent scurvy in sailors, leading to the identification of vitamin C as essential for health. By the mid-20th century, protective effects of many nutrients for deficiency diseases had been shown, including thiamine (beriberi), niacin (pellagra), vitamin D (rickets), vitamin A (night blindness), iron (anemia), and iodine (goiter). Early population-wide dietary guidelines therefore emphasized prevention of nutrient deficiencies. This emphasis assumed special urgency with the food shortages of the Great Depression and World War II, impelling the League of Nations, British Medical Association, and US Department of Agriculture to create new minimum requirements for calories, protein, calcium, phosphorus, iron, and various vitamins. Consequently, the first recommended dietary allowances (RDAs) were formulated in 1941, establishing a scientific basis for modern dietary guidelines. These efforts set a precedent, followed to this day, for the creation of guidelines by first considering nutrient targets and then translating these targets into food recommendations.

Bring Back Home Economics Education

Abstract: HOME ECONOMICS, OTHERWISE KNOWN AS DOMEStic education, was a fixture in secondary schools through the 1960s, at least for girls. The underlying concept was that future homemakers should be educated in the care and feeding of their families. This idea now seems quaint, but in the midst of a pediatric obesity epidemic and concerns about the poor diet quality of adolescents in the United States, instruction in basic food preparation and meal planning skills needs to be part of any long-term solution. About 35% of adolescents are overweight or obese, a prevalence that approaches 50% in minority populations. Excessive weight among youth affects virtually every organ system and, according to a recent study, increases the risk of premature death. In addition, obesity adversely affects selfesteem, academic accomplishment, and future earning potential of children. Programs meant to address obesity in youth have achieved limited success. Some localities have begun to screen students with body mass index (BMI) “report cards,” formed innovative relationships with farmers to supplement the school lunch with local produce, and enacted moratoriums on locating new fast food establishments in their neighborhoods. But powerful forces undermine these efforts, such as the ubiquitous advertising of foods and beverages high in calories and low in nutrient content. Michelle Obama’s “Let’s Move” campaign—with its emphasis on improving the quality of food and beverage in the schools and the community—is a welcome and historic step. However, better choices in schools will ultimately have limited effects if children do not have the ability to make better choices in the outside-school world, where they spend the majority of their time when young and which they inhabit when older. If children are raised to feel uncomfortable in the kitchen, they will be at a disadvantage for life. Two recent reports underscore the urgency of this situation. One story focusing on impoverished areas of the South Bronx identified a novel phenomenon in the United States: the coexistence of food insecurity and obesity in the same families and sometimes in the same individual. This “obesityhunger paradox” arises not only from lack of nutritious, affordable alternatives to fast food, but also from lack of knowledge about how to prepare nutritious food at home with inexpensive basic ingredients. At the other extreme, highend kitchen appliances now feature “smart” options for cookies, chicken nuggets, and omelets, allowing those with minimal cooking skills to prepare dishes or entire meals with the push of a button. Although the optimal diet for obesity and chronic disease prevention remains the subject of investigation, broad consensus exists regarding the benefits of home-prepared meals. Research suggests that frequent consumption of restaurant food, take-out food, and prepared snacks lowers dietary quality and promotes weight gain, and that food preparation by adolescents and young adults may have the opposite effect by displacing poor choices made outside the home. The increase in consumption of meals and snacks prepared away from home, now exceeding one-third of total calories among children and adolescents, appears related to the obesity epidemic. Even more than before, parents and caregivers today cannot be expected or relied on to teach children how to prepare healthy meals. Many parents never learned to cook and instead rely on restaurants, take-out food, frozen meals, and packaged food as basic fare. Many children seldom experience what a true home-cooked meal tastes like, much less see what goes into preparing it. Work schedules and child extracurricular programs frequently preclude involving children in food shopping and preparation. The family dinner has become the exception rather than the rule. To improve education about food, it is not necessary to bring back the classic home economics coursework, replete with gender-specific stereotypes. Rather, girls and boys should be taught the basic principles they will need to feed themselves and their families within the current food environment: a version of hunting and gathering for the 21st century. Through a combination of pragmatic instruction, field trips, and demonstrations, this curriculum would aim to transform meal preparation from an intimidating chore into a manageable and rewarding pur-

Extra calories cause weight gain--but how much?

Abstract: HOW MUCH WEIGHT WOULD AN INDIVIDUAL GAIN BY eating an extra chocolate chip cookie every day for life? One approach to answering this question, frequently used in textbooks and scientific articles, is based on the assumption that a pound (454 g) of fat tissue has about 3500 kilocalories (kcal). Thus, a daily 60-kcal cookie would be expected to produce 0.2 kg (0.5 lb) weight gain in a month, 2.7 kg (6 lb) in a year, 27 kg (60 lb) in a decade, and many hundreds of pounds in a lifetime. This of course does not happen. In this article, the physiology of weight gain and loss is reviewed, and the amount of reduction of caloric intake necessary to avoid becoming overweight or obese is estimated.

Front-of-Package Food Labels: Public Health or Propaganda?

Abstract: AT NO POINT IN US HISTORY HAVE FOOD PRODUCTS displayed so many symbols and statements proclaiming nutrition and health benefits. Front-ofpackage claims, often used in violation of Food and Drug Administration (FDA) labeling regulations, have become ubiquitous in food marketing. Recently, the FDA embarked on an initiative to review front-of-package labeling and asked the Institute of Medicine to consider eventual recommendation of a single, standardized guidance system. Front-of-package labels may so thoroughly mislead the public that another option deserves consideration— eliminate all nutrition and health claims from the front of processed food packages while strengthening the Nutrition Facts Panel.

Weight-loss maintenance--mind over matter?

Abstract: Many people can lose weight in the short term by reducing their intake of calories with the use of a variety of diets, ranging from low-fat to very-low-carbohydrate However, few people successfully maintain their weight loss1 One explanation for the poor efficacy of conventional diets relates to psychological factors, since the motivation to adhere to restrictive regimens diminishes with time, especially in an environment with virtually instantaneous availability of food A second, perhaps more fundamental, explanation is that weight loss elicits physiological adaptations — principally an increase in hunger and a decrease in resting energy expenditure2 — that oppose ongoing

Training in childhood obesity management in the United States: a survey of pediatric, internal medicine-pediatrics and family medicine residency program directors

Abstract: Background Information about the availability and effectiveness of childhood obesity training during residency is limited.

Propaganda? Front-of-Package Food Labels: Public Health or

Abstract: Contact me when new articles are published in these topic areas.