THIS STORY HAS BEEN FORMATTED FOR EASY PRINTING
Joanna Weiss

Striking a nerve on childhood obesity

Dr. David Ludwig Dr. David Ludwig (John Gillooly)
By Joanna Weiss
Globe Columnist / July 24, 2011

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DR. DAVID Ludwig knew he was peddling a provocative idea: that children who are so obese that their lives are in danger should be placed in foster care.

He just thought the debate would take on a reasonable tone.

What he’d co-written, after all, was a short, sober piece in the Journal of the American Medical Association, aimed at doctors and riddled with caveats.

“I expected a spirited scholarly debate,’’ Ludwig told me last week in his Longwood office, where he directs the Obesity Prevention Center at Children’s Hospital. “I did not expect this to be the commentary heard ’round the world.’’

Ah, but this is the modern media world, desperate for clicks and powered by rants. And Ludwig’s mildly worded piece hit a bundle of public nerves. Fear of government intervention. Stress about parenting skills. Concern that fat people are stigmatized, that pressure on parents has grown too great.

So on a Tuesday night, the Associated Press released a story about Ludwig’s piece, with the headline, “Should Parents Lose Custody of Super-Obese Kids?’’

And by Wednesday morning, the media panic/opportunism machine had kicked into overdrive. A New York Post header read, “Doctor says government should confiscate fat kids.’’ A Forbes blog decried “The War on Bad Parenting.’’ An online paper warned of “The Fat Gestapo.’’ On TV, “experts’’ questioned how the foster-care system could possibly cope with a flood of 2 million children, dragged screaming from their parents for the sin of being chubby.

Then came the angry e-mails and voice-mail messages, from strangers who found Ludwig through the hospital switchboard. A dentist wrote that he wanted to wire Ludwig’s mouth shut. A self-professed Christian wrote that Ludwig didn’t deserve to call himself an American.

Ludwig was shaken, but e-mailed nearly everyone back, politely asking people to read the JAMA piece itself. (The journal provided it, free of charge, for a week after the controversy hit.) He urged them to consider the full story, not just the headlines.

The full story is this: American children face an obesity epidemic that has grown worse over the past 30 years. Two million are characterized as extremely obese. But Ludwig and his co-author, attorney Lindsay Murtagh, were talking about a tiny handful of them, so severely overweight that their lives are in immediate danger.

One of those patients inspired Ludwig to write his JAMA piece: A girl he’d treated at Children’s, who weighed 90 pounds at 3 and 400 pounds by the time she was 14. Her parents struggled with substance abuse, physical disabilities, emotional problems, and financial woes. The state sent her to foster care, citing medical neglect.

Within a year, with a normal diet and moderate exercise, she had lost 130 pounds. She’s still in foster care, and a month ago told Ludwig, “I’m happy for the first time I can remember.’’

Happy, and lucky, because she could have died - from sleep apnea, cardiopulmonary collapse, or a diabetes-induced coma. Her weight could have caused irreversible harm: type 2 diabetes, fatty liver, a host of medical issues that can shorten a lifespan.

Ludwig wrote that families like hers need far more social services, and that foster care should only be a last resort. But it should be on the table, he wrote, as an alternate to surgery, a way to keep kids alive.

“Most people would be horrified if a child were systematically underfed, began to starve, and the state refused to help,’’ Ludwig said. “Why is that fundamentally different from a child who is so overfed that their life is now in danger?’’

It’s a reasonable question, but those have become increasingly hard to ask; you can’t suggest a modest solution to the obesity epidemic without facing a fiery backlash. People howl when Michelle Obama suggests they should eat more vegetables. They cry “nanny state’’ when Mayor Menino bans sugary drinks from vending machines.

And if we can’t agree on small steps, what do we do about these rare, extreme cases when a child’s life is at stake?

Maybe we tune out the headlines and the fear-mongering and find a way to talk about health issues quietly, one on one. Since Ludwig sent out his e-mail replies, responses have been trickling back in. The dentist has apologized. So has the Christian. And after reading the JAMA piece firsthand, both of them now think Ludwig is right.

Joanna Weiss can be reached at weiss@globe.com. Follow her on Twitter @JoannaWeiss.