Teaming up to fight obesity

(Correction: Because of a reporting error, a Page One story on Feb. 14 about a weight-loss program at Children's Hospital Boston incorrectly described pasta's effect on blood sugar levels. Pasta is low on the glycemic index, a measure of how quickly food raises blood sugar levels.)

Bobby Bilodeau, 14, has just spilled the beans: He admits to spending three hours a day on the computer, followed by an hour of television.

''That's a lot of time," says Children's Hospital Boston nutritionist Jan Hangen. She knows that two years ago, Bilodeau topped 200 pounds. Through intensive treatment, he has dropped weight but remains heavyset. She needles him: ''What would you like to do about it?"

''Well, it'll go down in the spring," he says.

''But it's winter now," she insists.

Finally, Bilodeau relents: ''I guess I could do more homework, and get outside more."

But the visit is not over. A doctor -- and another grilling -- awaits.

Bilodeau has made these visits every two to three months for two years as a patient in an intensive weight-loss program at Children's Hospital that offers novel strategies to combat child obesity and underscores the difficulties of grappling with the growing problem.

Last fall, the federal government issued a report stating that nearly every aspect of children's lives -- schools, parenting, advertising, and genetics -- conspires to fatten them. Nine million US boys and girls are obese, making them more likely to develop diabetes, heart disease, and numerous other illnesses. Increasing awareness of the problem has left parents and communities scrambling for answers. A Texas legislator recently proposed including children's weight and body-mass index score on school report cards. Arkansas schools last year began sending health reports on students to parents, and many others states and localities are considering similar measures, as well as laws, to regulate everything from school lunches to food advertising.

But in ''a society geared to promote obesity," said Michael F. Jacobson, executive director for the Center for Science in the Public Interest, what is needed are multipronged, intensive approaches like the Children's Hospital program. Called Optimal Weight for Life, it gives children advice and guidance, with a team of doctors, nurses, nutritionists, and behavioral specialists pushing patients and their parents to redesign their lives in a healthier fashion. The program follows children for months, often years, making adjustments and guarding against backsliding.

But the population of obese children far outnumbers the capacity of programs like OWL. Dr. David Ludwig began OWL in 1996 with just two staffers. Now the clinic has 14, and handles 3,000 patient visits annually -- but still has a six-month waiting list. Boston Medical Center has a similar program run by a former co-director at OWL. But treatment for most obese children begins and ends in a pediatrician's office.

''There's only so much they can do in their office," said Tufts University's Dr. Christina Economos, explaining that the average pediatrician is not trained to deal comprehensively with obesity. Last fall, the National Institutes of Health asked researchers for proposals to develop better ways to treat obesity in the standard doctors' office setting. The federal agency will soon issue grants to study the issue. Also, the American Academy of Pediatrics recently created a subcommittee to fashion ways to help pediatricians deal better with obesity.

Nutrition specialists hope that more hospitals and healthcare providers will invest in programs like OWL -- and that all health insurers will pay for it. Ludwig said some local insurers pay for a full course of treatment, which varies in cost and duration by patient. But some insurers refuse to cover OWL treatments, while others will cover only a set number of visits, some as few as three, which Ludwig called inadequate. Bilodeau's insurer, an affiliate of Blue Cross-Blue Shield, covers all his visits.

Bilodeau gained weight from an early age, said his mother, Mary-Liz Bilodeau, 49. He was constantly in front of the television. His daily diet was riddled with snack foods -- Doritos binges were commonplace. By middle school, he was attracting taunts. Children in passing cars yelled epithets as he played outside.

''I was a heavy kid when I was 12, 13 years old," said Mary-Liz Bilodeau. ''It was awful. I had been ridiculed as an overweight teenager. It was miserable. Kids made fun of me. I didn't want that for Bobby." So, she enrolled him in OWL two years ago.

After leaving Hangen's office, Bobby Bilodeau sees Ludwig. The soft-spoken Tyngsborough boy, who dreams of one day playing linebacker on the Bishop Guertin High School football team, flashes a shy smile at the doctor.

In front of Ludwig is a detailed case file on the teen charting his weight and height fluctuations over two years, and detailing the shifts in his diet and exercise, and even his school history and social life. Ludwig queries him about his inadequate vegetable consumption, a continuing problem. His mother answers for him: ''The only one he'll eat is broccoli." Ludwig turns back to him, asking, ''What's your deal with vegetables?"

A key aspect of Ludwig's approach is the low-glycemic index diet. The glycemic index refers to changes in blood sugar levels. A handful of studies have indicated that keeping low glycemic index levels reduces hunger, keeping dieters satisfied. Refined carbohydrates, like white bread and pasta, cause glycemic index spikes, as do sugary soft drinks and juices. But ''good" carbohydrates like all-natural oatmeal, peanuts, and certain fruits do not, studies indicate. And lean meats and proteins help keep glycemic index levels low. Ludwig said that the diet, while not supported by long-term studies, is balanced and reduces hunger, making it easier to follow for years. Most dieters regain their weight because they cannot maintain a diet.

But beyond the diet, it is OWL's intensive monitoring and multidisciplinary approach that obesity specialists say is crucial. After a morning of seeing patients, including Bilodeau, the OWL staff convenes in a conference room. There are doctors, nutritionists, and nurses -- 11 specialists in all.

They go through the day's cases, whose lives show the complexities behind obesity. There is a 13-year-old boy whose weight has plummeted, a success story. More problematic is a 15-year-old boy, an aspiring rapper hopelessly addicted to junk food and with early signs of diabetes. A new patient, a 13-year-old girl, drinks 20 cups of Kool-Aid and sugary juice daily, drawing gasps. Then, a more troubling case: a young girl who gained weight after being raped, and is being pushed by her mother to quickly slim down to win a college soccer scholarship.

Regarding Bobby Bilodeau, Ludwig says he feels confident: ''He's got a loving, supportive family. They're committed to a healthful lifestyle, and they know a good deal about nutrition."

Later, Bilodeau's mother says the program has made her son -- and entire family -- hyperconscious about health. Their shopping habits have changed. Their leisure habits have changed. They read food labels with zeal. And the regular needling from OWL's staff helps, too.

''It's helpful to check in, to validate what you're doing. . . . It holds him accountable," said Mary-Liz Bilodeau ''It's a program that teaches you to make good decisions."

Bobby Bilodeau can now discuss food labels and calories like a dieting fashion model. He has started running laps around the neighborhood, and plans to start an intensive work-out program this summer. His TV time has gradually decreased. His classmates have been encouraging. And then there was the ultimate compliment: After years of wearing sweats, he has been persuaded by the girls at school to try jeans.

''I feel that I'm more confident," he said. ''I can do it."

Raja Mishra can be reached at rmishra@globe.com.