American kids are becoming obese, or nearly so, at an increasingly young age, with about one-third of them falling into that category by the time they're 9 months old, researchers have found.
There are some caveats about the research, however. The infants were not studied recently: They were born about a decade ago. And it's not clear how excess weight in babies may affect their health later in their lives. The study found no guarantee that a baby who's overweight at 9 months will stay flabby when his or her second birthday rolls around.
Still, the study -- in the January-February 2011 issue of the American Journal of Health Promotion -- does present a picture of babies and infants who are carrying around a lot of extra weight.
The findings also suggest that small changes in an infant's diet can make a big difference, said Dr. Wendy Slusser, medical director of a children's weight program at Mattel Children's Hospital at the University of California, Los Angeles. For example, she said, "if you don't give your kid juice and have them eat the fruit instead, suddenly there's 150 calories less a day that can make a big difference in weight gain over a long term."
The researchers examined federal data about 16,400 children in the United States who were born in 2001. After adjusting the statistics so they wouldn't be thrown off by such factors as high numbers of certain kinds of kids, the study authors found that 17 percent of 9-month-olds were obese and 15 percent were at risk for obesity, for a total of 32 percent.
At two years, 21 percent were obese and 14 percent were at risk of becoming obese, the investigators found.
"It seems like there tends to be a shift to kids getting heavier" over time, said the study's lead author, Brian G. Moss, an adjunct faculty member at Wayne State University School of Social Work. And their weight gain, he said, is beyond that which would be expected as youngsters grow.
Hispanics and poor kids as a whole were at highest risk, the study found, whereas girls and Asian/Pacific Islanders had the lowest risk.
But why are young children so heavy and getting heavier, as a whole, over time? The study didn't examine the reasons. Moss said the changes could have something to do with changes in their lives, such as entering daycare or starting to eat regular food, but the precise causes are not clear.
However, the research does suggest that infants aren't doomed to be overweight once they put on extra pounds, said Slusser, the children's hospital medical director. "There's this fluidity," she said, "a lot of movement back and forth into these categories."
So what is her advice for those who have an infant or one on the way? "You really need to reflect on the habits you have with your child," Slusser said. For instance, make sure the infant gets regular meals and snacks along with a good night's sleep and naps, she said. And pick a daycare center that offers healthy foods and opportunities for moving around.
And breast-feeding, she said, is ideal -- especially during the first six months, when specialists recommend that breast milk should be the exclusive source of food for babies.
Showing posts with label obese. Show all posts
Showing posts with label obese. Show all posts
Friday, January 28, 2011
Wednesday, December 15, 2010
Obese Adolescents at Greatest Risk of Becoming Severely Obese Adults
Obese adolescents are 16 times more likely to become severely obese by age 30 than their healthy weight or even overweight peers, according to a new study....
Public health researchers found that nearly 40 percent of obese adolescents are expected to become severely obese by age 30, compared to only 2.5 percent of healthy weight and overweight teenagers.
It is believed to be the first longitudinal study to examine the persistence and development of severe obesity over the transition from the teenage to adult years.
The link found between adolescent obesity and adult severe obesity suggests intervention programs might be most effective during childhood or adolescence, before the worst weight gain occurs, said senior study author Penny Gordon-Larsen, Ph.D., associate professor of nutrition in the University of North Carolina Gillings School of Global Public Health and a fellow of the Carolina Population Center.
"Severe obesity can lead to life-threatening complications, including diabetes, hypertension, hyperlipidemia, asthma and arthritis, as well as substantial reductions in life expectancy," she said. "It's critical that we identify who is most at risk for this condition, and when they are most vulnerable to it. Then we'll have better evidence for when and how to effectively intervene."
Current weight loss drugs are either minimally effective or come with a high risk of side effects, while people who have bariatric surgery, or "stomach stapling" operations, can suffer major potential complications, said Natalie The, Ph.D., postdoctoral research associate and lead author of the study. Therefore, preventing severe obesity may be the most effective strategy to avoid obesity-related health risks, she said.
Researchers defined adult severe obesity as a body mass index (BMI) of greater than or equal to 40, and being overweight and obese as a BMI greater than 25. The study found that while 1.2 percent of males and 2.4 percent of females who were normal weight as adolescents became severely obese as adults, 37 percent of males and 51 percent of females who were obese as adolescents became severely obese as adults. The risk of becoming severely obese was highest in black females.
"While we know that the transition from the teenage years to the adult years is one of high risk for weight gain, few studies have tracked individuals over time to understand the risk of developing severe obesity."
To measure the association between obesity in adolescence and severe obesity in adulthood, researchers studied data from the U.S. National Longitudinal Study of Adolescent Health. More than 8,800 people aged 12-21 in 1996 were followed into adulthood (ages 24-33 in 2007-2009).
Results showed that across all weight, sex and racial and ethnic groups, 7.9 percent of these teenagers who were not severely obese as adolescents became severely obese as young adults 13 years later. On the other hand, 70 percent of the teens who were severely obese remained so as they aged.
On average, over the period of the study, a teenage female of 5 feet 4 inches tall weighing 130 pounds who never developed severe obesity gained about 30 pounds; however a female of the same height who did become severely obese gained about 80 pounds.
"Obese adolescents are at considerably high risk for becoming adults with severe obesity," Gordon-Larsen said. "Given the rapid rise in severe obesity and its associated health risks, early prevention efforts are critically needed."
Public health researchers found that nearly 40 percent of obese adolescents are expected to become severely obese by age 30, compared to only 2.5 percent of healthy weight and overweight teenagers.
It is believed to be the first longitudinal study to examine the persistence and development of severe obesity over the transition from the teenage to adult years.
The link found between adolescent obesity and adult severe obesity suggests intervention programs might be most effective during childhood or adolescence, before the worst weight gain occurs, said senior study author Penny Gordon-Larsen, Ph.D., associate professor of nutrition in the University of North Carolina Gillings School of Global Public Health and a fellow of the Carolina Population Center.
"Severe obesity can lead to life-threatening complications, including diabetes, hypertension, hyperlipidemia, asthma and arthritis, as well as substantial reductions in life expectancy," she said. "It's critical that we identify who is most at risk for this condition, and when they are most vulnerable to it. Then we'll have better evidence for when and how to effectively intervene."
Current weight loss drugs are either minimally effective or come with a high risk of side effects, while people who have bariatric surgery, or "stomach stapling" operations, can suffer major potential complications, said Natalie The, Ph.D., postdoctoral research associate and lead author of the study. Therefore, preventing severe obesity may be the most effective strategy to avoid obesity-related health risks, she said.
Researchers defined adult severe obesity as a body mass index (BMI) of greater than or equal to 40, and being overweight and obese as a BMI greater than 25. The study found that while 1.2 percent of males and 2.4 percent of females who were normal weight as adolescents became severely obese as adults, 37 percent of males and 51 percent of females who were obese as adolescents became severely obese as adults. The risk of becoming severely obese was highest in black females.
"While we know that the transition from the teenage years to the adult years is one of high risk for weight gain, few studies have tracked individuals over time to understand the risk of developing severe obesity."
To measure the association between obesity in adolescence and severe obesity in adulthood, researchers studied data from the U.S. National Longitudinal Study of Adolescent Health. More than 8,800 people aged 12-21 in 1996 were followed into adulthood (ages 24-33 in 2007-2009).
Results showed that across all weight, sex and racial and ethnic groups, 7.9 percent of these teenagers who were not severely obese as adolescents became severely obese as young adults 13 years later. On the other hand, 70 percent of the teens who were severely obese remained so as they aged.
On average, over the period of the study, a teenage female of 5 feet 4 inches tall weighing 130 pounds who never developed severe obesity gained about 30 pounds; however a female of the same height who did become severely obese gained about 80 pounds.
"Obese adolescents are at considerably high risk for becoming adults with severe obesity," Gordon-Larsen said. "Given the rapid rise in severe obesity and its associated health risks, early prevention efforts are critically needed."
Monday, September 13, 2010
Weight Loss with Low-Carb or Low-Fat Diets
Obese patients lost similar amounts of weight over two years with either a low-fat or low-carbohydrate diet, but the latter had a more favorable effect on HDL cholesterol, data from a randomized trial showed....
Weight loss averaged 24 lbs. (11 kg) at one year and 15 lbs (7 kg) at two years with no significant differences between groups, according to Gary D. Foster, PhD, of Temple University in Philadelphia, PA, and co-authors. However, patients assigned to the low-carbohydrate diet had more rapid early declines in blood pressure, triglycerides, and VLDL cholesterol and greater increases in HDL throughout the study, they reported.
"This two-year multicenter study of more than 300 participants revealed that neither dietary fat nor carbohydrate intake influenced weight loss when combined with a comprehensive lifestyle intervention," they wrote. "Both diet groups achieved clinically significant and nearly identical weight loss… These long-term data suggest that a low-carbohydrate approach is a viable option for obesity treatment for obese adults."
Several randomized trials have shown that people on low-carbohydrate diets achieve greater short-term weight loss than those on low-fat, calorie-restricted diets, but long-term results have been mixed.
Nor have low-carbohydrate and low-fat diets been examined closely to determine whether they differ with respect to outcomes other than weight loss.
Foster and colleagues sought to inform on some of those issues by conducting a randomized, multicenter clinical trial that had weight loss as its primary outcome but also assessed cardiovascular risk factors, bone mineral density, and general symptoms. They hypothesized that a low-carbohydrate diet would result in greater weight loss at two years compared with a low-calorie, low-fat diet.
The study involved 307 patients with a mean age of 45, mean body mass index of 36, and mean weight of 103 kg (227 lbs). Two-thirds of the participants were women, and 70% were white. Investigators excluded patients with dyslipidemia or diabetes.
The low-carbohydrate diet limited carbohydrate intake to 20 g/d for 12 weeks and then increased by 5 g/d per week. Participants in this group could consume as much fat and protein as they wanted. Limiting carbohydrate intake was the primary behavioral focus for this group.
The low-fat diet was also calorie-restricted: 1,200-1,500 kcal/d for women and 1,500-1,800 kcal/d for men. Carbohydrates accounted for about 55% of calories, fat for 30%, and protein for 15%. Limiting total energy intake (kcal/d) was the primary behavioral target for the group.
Both groups reached maximum weight loss (11 to 12 kg) after six months. They did not differ significantly with respect to absolute weight loss at one year (about 11 kg) or at two years (7.37 kg in the low-fat group versus 6.34 kg in the low-carbohydrate group, P=0.41).
The only significant difference in weight loss occurred at three months, when the low-carbohydrate group averaged 9.49 kg versus 8.37 kg in the low-fat group (P=0.019). The trend over the entire 24 months of the trial did not differ significantly (P=0.30). The groups did differ with respect to several secondary endpoints, however.
The low-carbohydrate diet was associated with more rapid reductions in triglycerides and VLDL cholesterol, which differed significantly between groups after three months. The groups did not differ at 24 months, but the overall trend in VLDL favored the low-carbohydrate diet (P=0.027).
The low-fat diet led to greater reductions in LDL at all time points. Mean LDL increased in the low-carbohydrate group during the first six months before declining at one year. The overall trend favored the low-fat diet (P=0.0009).
HDL increased more rapidly with the low-carbohydrate diet and remained significantly different from the low-fat group at all four time points (P=0.008 to P<0.001) and in the overall analysis (P=0.0058).
The low-carbohydrate diet led to small but statistically greater reductions in total cholesterol (P=0.030 for trend).
Systolic blood pressure did not differ significantly between groups at any point in time. The low-carbohydrate diet resulted in significantly greater reductions in diastolic blood pressure at three of four intervals, but the overall trend was not significant (P=0.36).
The authors noted hypothetical concerns that a low-carbohydrate diet might lead to greater loss in bone mineral density, but the two groups did not differ with respect to changes in BMD at any time during the study, and the declines in BMD were within expected ranges.
Participants in the low-carbohydrate group reported significantly more adverse effects, particularly during the first six to 12 months of the study. The low-carbohydrate diet was associated with more reports of bad breath, hair loss, constipation, and dry mouth. However, trends over the entire trial did not differ significantly for any of these.
Weight loss averaged 24 lbs. (11 kg) at one year and 15 lbs (7 kg) at two years with no significant differences between groups, according to Gary D. Foster, PhD, of Temple University in Philadelphia, PA, and co-authors. However, patients assigned to the low-carbohydrate diet had more rapid early declines in blood pressure, triglycerides, and VLDL cholesterol and greater increases in HDL throughout the study, they reported.
"This two-year multicenter study of more than 300 participants revealed that neither dietary fat nor carbohydrate intake influenced weight loss when combined with a comprehensive lifestyle intervention," they wrote. "Both diet groups achieved clinically significant and nearly identical weight loss… These long-term data suggest that a low-carbohydrate approach is a viable option for obesity treatment for obese adults."
Several randomized trials have shown that people on low-carbohydrate diets achieve greater short-term weight loss than those on low-fat, calorie-restricted diets, but long-term results have been mixed.
Nor have low-carbohydrate and low-fat diets been examined closely to determine whether they differ with respect to outcomes other than weight loss.
Foster and colleagues sought to inform on some of those issues by conducting a randomized, multicenter clinical trial that had weight loss as its primary outcome but also assessed cardiovascular risk factors, bone mineral density, and general symptoms. They hypothesized that a low-carbohydrate diet would result in greater weight loss at two years compared with a low-calorie, low-fat diet.
The study involved 307 patients with a mean age of 45, mean body mass index of 36, and mean weight of 103 kg (227 lbs). Two-thirds of the participants were women, and 70% were white. Investigators excluded patients with dyslipidemia or diabetes.
The low-carbohydrate diet limited carbohydrate intake to 20 g/d for 12 weeks and then increased by 5 g/d per week. Participants in this group could consume as much fat and protein as they wanted. Limiting carbohydrate intake was the primary behavioral focus for this group.
The low-fat diet was also calorie-restricted: 1,200-1,500 kcal/d for women and 1,500-1,800 kcal/d for men. Carbohydrates accounted for about 55% of calories, fat for 30%, and protein for 15%. Limiting total energy intake (kcal/d) was the primary behavioral target for the group.
Both groups reached maximum weight loss (11 to 12 kg) after six months. They did not differ significantly with respect to absolute weight loss at one year (about 11 kg) or at two years (7.37 kg in the low-fat group versus 6.34 kg in the low-carbohydrate group, P=0.41).
The only significant difference in weight loss occurred at three months, when the low-carbohydrate group averaged 9.49 kg versus 8.37 kg in the low-fat group (P=0.019). The trend over the entire 24 months of the trial did not differ significantly (P=0.30). The groups did differ with respect to several secondary endpoints, however.
The low-carbohydrate diet was associated with more rapid reductions in triglycerides and VLDL cholesterol, which differed significantly between groups after three months. The groups did not differ at 24 months, but the overall trend in VLDL favored the low-carbohydrate diet (P=0.027).
The low-fat diet led to greater reductions in LDL at all time points. Mean LDL increased in the low-carbohydrate group during the first six months before declining at one year. The overall trend favored the low-fat diet (P=0.0009).
HDL increased more rapidly with the low-carbohydrate diet and remained significantly different from the low-fat group at all four time points (P=0.008 to P<0.001) and in the overall analysis (P=0.0058).
The low-carbohydrate diet led to small but statistically greater reductions in total cholesterol (P=0.030 for trend).
Systolic blood pressure did not differ significantly between groups at any point in time. The low-carbohydrate diet resulted in significantly greater reductions in diastolic blood pressure at three of four intervals, but the overall trend was not significant (P=0.36).
The authors noted hypothetical concerns that a low-carbohydrate diet might lead to greater loss in bone mineral density, but the two groups did not differ with respect to changes in BMD at any time during the study, and the declines in BMD were within expected ranges.
Participants in the low-carbohydrate group reported significantly more adverse effects, particularly during the first six to 12 months of the study. The low-carbohydrate diet was associated with more reports of bad breath, hair loss, constipation, and dry mouth. However, trends over the entire trial did not differ significantly for any of these.
Tuesday, September 7, 2010
Teens with Type 2 Diabetes Have Brain Abnormalities
Obese adolescents with Type 2 diabetes have diminished cognitive performance and subtle abnormalities in the brain, researchers at NYU Langone Medical Center found…
Antonio Convit, MD, professor of Psychiatry and Medicine at NYU Langone Medical Center and the Nathan S. Kline Institute for Psychiatric Research, NY, explained that, "This is the first study that shows that children with Type 2 diabetes have more cognitive dysfunction and brain abnormalities than equally obese children who did not yet have marked metabolic dysregulation from their obesity."
"The findings are significant because they indicate that insulin resistance from obesity is lowering children's cognitive performance, which may be affecting their ability to perform well in school."
Researchers studied 18 obese adolescents with Type 2 diabetes and compared them to equally obese adolescents from the same socio-economic and ethnic background but without evidence of marked insulin resistance or pre-diabetes.
Investigators found that adolescents with Type 2 diabetes not only had significant reductions in performance on tests that measure overall intellectual functioning, memory, and spelling, which could affect their school performance, but also had clear abnormalities in the integrity of the white matter in their brains.
"Now we see that subtle changes in white matter of the brain in adolescents may be a result of the abnormal physiology that accompanies Type 2 diabetes. If we can improve insulin sensitivity and help children through exercise and weight loss , perhaps we can reverse these deficits."
Antonio Convit, MD, professor of Psychiatry and Medicine at NYU Langone Medical Center and the Nathan S. Kline Institute for Psychiatric Research, NY, explained that, "This is the first study that shows that children with Type 2 diabetes have more cognitive dysfunction and brain abnormalities than equally obese children who did not yet have marked metabolic dysregulation from their obesity."
"The findings are significant because they indicate that insulin resistance from obesity is lowering children's cognitive performance, which may be affecting their ability to perform well in school."
Researchers studied 18 obese adolescents with Type 2 diabetes and compared them to equally obese adolescents from the same socio-economic and ethnic background but without evidence of marked insulin resistance or pre-diabetes.
Investigators found that adolescents with Type 2 diabetes not only had significant reductions in performance on tests that measure overall intellectual functioning, memory, and spelling, which could affect their school performance, but also had clear abnormalities in the integrity of the white matter in their brains.
"Now we see that subtle changes in white matter of the brain in adolescents may be a result of the abnormal physiology that accompanies Type 2 diabetes. If we can improve insulin sensitivity and help children through exercise and weight loss , perhaps we can reverse these deficits."
Tuesday, August 10, 2010
You Can Help Children Avoid Type 2 Diabetes
Type 2 diabetes is affecting kids in a big way, but diet and exercise can help children avoid or reverse this condition.
Once upon a time, type 2 diabetes was called “adult-onset diabetes.” If children had diabetes, 99 times out of 100 it was type 1 diabetes; type 2 diabetes didn’t appear until midlife. Now, studies suggest that up to 45 percent of childhood diabetes cases are type 2 diabetes.
Type 2 Diabetes: Why the Increase?
“No one is certain why, but most experts believe that it is related in part to the obesity epidemic,” explains Frank Diamond, MD, clinical director for the University of South Florida Diabetes Center and professor of pediatrics at the University of South Florida in Tampa. “We now have approximately 17 percent of the pediatric population that is overweight. Genetically at-risk children may be acquiring the disease earlier because of the increased insulin resistance associated with their early obesity. We are seeing many children with adult weights in our pediatric clinics today.”
Dr. Diamond also notes that the increase may be due to a rise in the proportion of children with ethnic minority heritage that puts them at increased risk for type 2 diabetes.
Basically, says Paul Robertson, MD, president of medicine and science at the American Diabetes Association, and professor of medicine and pharmacology at the University of Washington in Seattle, the causes of childhood type 2 diabetes boil down to genetic risk mixed with physical inactivity and poor eating habits.
“We know if the diets are corrected and they lose the weight, the diabetes becomes undetectable,” says Dr. Robertson.
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Type 2 Diabetes: What Parents Can Do
The first step to preventing type 2 diabetes in childhood is to face the fact that it can happen to children, says Diamond. Then be on guard for symptoms and ask for diabetes screening.
“Symptoms include tiring easily, thirst, and increased urination. A darkening of the skin (acanthosis nigricans) on the back of the neck, under the arms, and in the groin area is associated with obesity and [is] a common finding with newly diagnosed type 2 diabetes children,” he says.
Also, bear in mind that if you had gestational diabetes during your pregnancy, your children are at increased risk of type 2 diabetes.
“Especially in families with a positive family history of type 2 diabetes, avoidance of excessive weight gain and encouragement of an active lifestyle are extremely important and the best tools to avoid the development of type 2 diabetes,” says Diamond. Some children may be candidates for a drug called metformin.
Type 2 Diabetes: Testing
Parents who are concerned that their child might have diabetes should ask for a fasting glucose screening test. That test determines how much sugar is in the blood before a person has eaten.
“A value over 99 mg/dL is abnormal and suggests ‘impending’ diabetes or glucose intolerance. A value equal to or greater than 126 mg/dL is diagnostic of diabetes,” says Diamond.
Any results above the normal range should be red flags for you and your family to:
* Eat a healthy diet rich in whole grains, lean proteins, fruits, and veggies. You can get help changing your family’s diet from a dietitian, if necessary.
* Get at least 30 minutes of exercise a day.
* Help your child lose at least 5 percent of his body weight if he is overweight.
Remember, childhood type 2 diabetes is within your family’s control.
“Lose weight, be active, eat the right foods,” says Robertson. “Lifestyle modifications can do a great deal in terms of staving off type 2 diabetes.”
Last Updated: 04/16/2009
This section created and produced exclusively by the editorial staff of EverydayHealth.com. © 2010 EverydayHealth.com; all rights reserved.
Once upon a time, type 2 diabetes was called “adult-onset diabetes.” If children had diabetes, 99 times out of 100 it was type 1 diabetes; type 2 diabetes didn’t appear until midlife. Now, studies suggest that up to 45 percent of childhood diabetes cases are type 2 diabetes.
Type 2 Diabetes: Why the Increase?
“No one is certain why, but most experts believe that it is related in part to the obesity epidemic,” explains Frank Diamond, MD, clinical director for the University of South Florida Diabetes Center and professor of pediatrics at the University of South Florida in Tampa. “We now have approximately 17 percent of the pediatric population that is overweight. Genetically at-risk children may be acquiring the disease earlier because of the increased insulin resistance associated with their early obesity. We are seeing many children with adult weights in our pediatric clinics today.”
Dr. Diamond also notes that the increase may be due to a rise in the proportion of children with ethnic minority heritage that puts them at increased risk for type 2 diabetes.
Basically, says Paul Robertson, MD, president of medicine and science at the American Diabetes Association, and professor of medicine and pharmacology at the University of Washington in Seattle, the causes of childhood type 2 diabetes boil down to genetic risk mixed with physical inactivity and poor eating habits.
“We know if the diets are corrected and they lose the weight, the diabetes becomes undetectable,” says Dr. Robertson.
There's more content below this advertisement. Jump to the content.
Type 2 Diabetes: What Parents Can Do
The first step to preventing type 2 diabetes in childhood is to face the fact that it can happen to children, says Diamond. Then be on guard for symptoms and ask for diabetes screening.
“Symptoms include tiring easily, thirst, and increased urination. A darkening of the skin (acanthosis nigricans) on the back of the neck, under the arms, and in the groin area is associated with obesity and [is] a common finding with newly diagnosed type 2 diabetes children,” he says.
Also, bear in mind that if you had gestational diabetes during your pregnancy, your children are at increased risk of type 2 diabetes.
“Especially in families with a positive family history of type 2 diabetes, avoidance of excessive weight gain and encouragement of an active lifestyle are extremely important and the best tools to avoid the development of type 2 diabetes,” says Diamond. Some children may be candidates for a drug called metformin.
Type 2 Diabetes: Testing
Parents who are concerned that their child might have diabetes should ask for a fasting glucose screening test. That test determines how much sugar is in the blood before a person has eaten.
“A value over 99 mg/dL is abnormal and suggests ‘impending’ diabetes or glucose intolerance. A value equal to or greater than 126 mg/dL is diagnostic of diabetes,” says Diamond.
Any results above the normal range should be red flags for you and your family to:
* Eat a healthy diet rich in whole grains, lean proteins, fruits, and veggies. You can get help changing your family’s diet from a dietitian, if necessary.
* Get at least 30 minutes of exercise a day.
* Help your child lose at least 5 percent of his body weight if he is overweight.
Remember, childhood type 2 diabetes is within your family’s control.
“Lose weight, be active, eat the right foods,” says Robertson. “Lifestyle modifications can do a great deal in terms of staving off type 2 diabetes.”
Last Updated: 04/16/2009
This section created and produced exclusively by the editorial staff of EverydayHealth.com. © 2010 EverydayHealth.com; all rights reserved.
Friday, July 2, 2010
Obesity, Other Risk Factors for Youth Diabetes Improved by Broad, School-based Intervention Program
One of the important announcements coming out of the American Diabetes Association's 70th Scientific Sessions were the results of a little known NIH study titled, "The Healthy Study: Interventions to reduce early diabetes risk." This may be a new model of how we can prevent our children from getting diabetes....
The NIH made a major investment in our children by modifying lifestyles in the grade schools to prevent a number of diseases. They also have a website that has all of the materials used in the program available at no cost: www.healthystudy.com.
A broad-based program to fight obesity and diabetes, aimed at US middle-school students and conducted directly by their teachers and other local school officials and designed to profoundly change not only diet, but also attitudes about food and fitness, appeared to improve measures of adiposity, insulin resistance, and other diabetes risk factors in a prospective randomized trial. The findings were presented here on June 28 at the 70th ADA Scientific Sessions and published online June 27, 2010, in the New England Journal of Medicine.
However, there wasn't a significant difference between students at schools that ran the three-year program and control schools, where the program wasn't instituted, in the study's primary end point: change in the prevalence of kids who were overweight or obese, defined as a body-mass index (BMI) in the >85th percentile. The prevalence fell similarly at schools with and without the intervention program.
By 1999, some pediatric centers, especially those in inner cities, were seeing more new cases of Type 2 diabetes than Type 1.
The program, which followed the students from the beginning of sixth grade to the end of eighth grade, also did not show a significant benefit in lowering the overall prevalence of kids who were obese at its conclusion -- that is, who finished the study in the >95th percentile for BMI. That prevalence fell by 19% at program compared with nonprogram schools, but the difference fell just short of significance at p=0.05.
However, the proportion of kids with waist circumference in the >90th percentile fell significantly more (p=0.04) at program schools. Students at those schools also had significantly (p=0.04) smaller increases in fasting insulin levels over the three years.
The program's benefits in the overall school populations were even more pronounced, and more solidly significant, among the approximately one-half of students in the >85th percentile for BMI at the beginning of sixth grade.
"This would suggest that, although the intervention did not meet its primary outcome of altering the combined prevalence of overweight or obesity, it did have effects on obesity and other important risk factors for Type 2 diabetes, Dr. Gary D. Foster (Temple University, Philadelphia, PA) said at a briefing for medical reporters. Foster chaired the HEALTHY study -- a name, not an acronym, chosen by students who participated in the comprehensive program.
He also said that the falling overweight/obesity rates at schools with and without the intervention program are consistent with national-level trends observed in other analyses that suggest that "rates of obesity in high-risk children in sixth to eighth grade appear not to be steady or increasing, but actually appear to be declining."
The HEALTHY study randomized 42 schools in seven regions of the US to follow or not follow the comprehensive intervention program. Schools qualified for participation if at least 50% of their students were members of a minority (primarily Hispanic or African American) or at least 50% qualified for government-subsidized meal programs; minority and low-income kids, the researchers note, are known to be at increased risk for both obesity and diabetes. Girls made up 53% of the 4,603 students tracked in the study, who had to be free of recognized diabetes at baseline.
At the press briefing, Dr. Griffin P. Rodgers (National Institutes of Health, Bethesda, MD), who is director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the HEALTHY study's primary underwriter, but who isn't one of its investigators, underscored the importance of targeting kids at increased risk for diabetes. "Earlier onset of diabetes may foreshadow earlier appearance of complications," he noted.
When the HEALTHY study and its six preceding pilot studies were initially in development, he continued, "obesity rates in American youth had been climbing steadily for two decades. Then, medical centers around the country began reporting a disturbing new trend, Type 2 diabetes was increasingly being diagnosed in youths, especially black, Hispanic, and American Indian adolescents. By 1999, some pediatric centers, especially those in inner cities, were seeing more new cases of Type 2 diabetes than Type 1. We needed to find ways to contain the rising rate of Type 2 diabetes in kids, and schools were a logical place to start."
Dr. Cynthia L. Ogden (Centers for Disease Control and Prevention, Atlanta, GA), also on hand at the briefing but not a HEALTHY study researcher, showed 2007/08 data from the National Health and Nutrition Examination Survey suggesting that 31.7% of US children aged two to 19 are overweight or obese, amounting to 23.4 million children. Among them, she said, are the 17% of US kids in that age group, a total of about 12.5 million, who qualify as obese.
Also, Rodgers said, the HEALTHY pilot trials suggested that up to 40% of eighth graders at schools with high-risk populations had elevated fasting glucose levels. "So the question became, can changes in schools -- namely, longer and more intense gym classes, healthier food choices, and classroom activities that promote healthy behavior -- lower risk factors for Type 2 diabetes in youth?"
The program consisted of interventions grouped in four domains. (Details and the materials used are available on the study's website.) The nutritional component called for healthy improvements in the quality and quantity of food and beverages available at the schools' cafeterias, snack bars, and vending machines, and even at fundraisers and classroom parties, according to Hirst. Available choices shifted to those lower in fat, higher in fiber, heavier on fruit and vegetables, and lower in added sugar.
The physical-activity component was aimed at increasing both participation and activity levels in physical education classes, emphasizing activities that raised the heart rate.
Dr. Kathryn Hirst (George Washington University School of Public Health, Washington, DC) provided more details of the intervention program, which consisted of "multiple components that were designed to change the school environment radically." Experts on the study's staff at its seven regional field offices provided "training, guidance, assistance, materials, and support" for instituting the program to the faculties and staff at each of the schools, "who were the ones who actually delivered the intervention," she noted.
Teachers received instruction on holding school-wide events that promoted physical activity. Minimum weekly durations of physical education classes were instituted.
The third component, focused on behavior, according to the report, promoted classroom and family-outreach activities to educate and sharpen self-awareness and decision-making, self-monitoring, and goal-setting skills consistent with the overall program.
The fourth component, communication, focused on the use of marketing techniques to promote the program's goals within the schools and establish a "brand" to characterize and identify the changes to menus and physical activities that were part of the program.
Healthy Study Group. A school-based intervention for diabetes risk reduction. New Engl J Med 2010; DOI:10.1056/NEJMoa1001933. Available at www.nejm.org.
The NIH made a major investment in our children by modifying lifestyles in the grade schools to prevent a number of diseases. They also have a website that has all of the materials used in the program available at no cost: www.healthystudy.com.
A broad-based program to fight obesity and diabetes, aimed at US middle-school students and conducted directly by their teachers and other local school officials and designed to profoundly change not only diet, but also attitudes about food and fitness, appeared to improve measures of adiposity, insulin resistance, and other diabetes risk factors in a prospective randomized trial. The findings were presented here on June 28 at the 70th ADA Scientific Sessions and published online June 27, 2010, in the New England Journal of Medicine.
However, there wasn't a significant difference between students at schools that ran the three-year program and control schools, where the program wasn't instituted, in the study's primary end point: change in the prevalence of kids who were overweight or obese, defined as a body-mass index (BMI) in the >85th percentile. The prevalence fell similarly at schools with and without the intervention program.
By 1999, some pediatric centers, especially those in inner cities, were seeing more new cases of Type 2 diabetes than Type 1.
The program, which followed the students from the beginning of sixth grade to the end of eighth grade, also did not show a significant benefit in lowering the overall prevalence of kids who were obese at its conclusion -- that is, who finished the study in the >95th percentile for BMI. That prevalence fell by 19% at program compared with nonprogram schools, but the difference fell just short of significance at p=0.05.
However, the proportion of kids with waist circumference in the >90th percentile fell significantly more (p=0.04) at program schools. Students at those schools also had significantly (p=0.04) smaller increases in fasting insulin levels over the three years.
The program's benefits in the overall school populations were even more pronounced, and more solidly significant, among the approximately one-half of students in the >85th percentile for BMI at the beginning of sixth grade.
"This would suggest that, although the intervention did not meet its primary outcome of altering the combined prevalence of overweight or obesity, it did have effects on obesity and other important risk factors for Type 2 diabetes, Dr. Gary D. Foster (Temple University, Philadelphia, PA) said at a briefing for medical reporters. Foster chaired the HEALTHY study -- a name, not an acronym, chosen by students who participated in the comprehensive program.
He also said that the falling overweight/obesity rates at schools with and without the intervention program are consistent with national-level trends observed in other analyses that suggest that "rates of obesity in high-risk children in sixth to eighth grade appear not to be steady or increasing, but actually appear to be declining."
The HEALTHY study randomized 42 schools in seven regions of the US to follow or not follow the comprehensive intervention program. Schools qualified for participation if at least 50% of their students were members of a minority (primarily Hispanic or African American) or at least 50% qualified for government-subsidized meal programs; minority and low-income kids, the researchers note, are known to be at increased risk for both obesity and diabetes. Girls made up 53% of the 4,603 students tracked in the study, who had to be free of recognized diabetes at baseline.
At the press briefing, Dr. Griffin P. Rodgers (National Institutes of Health, Bethesda, MD), who is director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the HEALTHY study's primary underwriter, but who isn't one of its investigators, underscored the importance of targeting kids at increased risk for diabetes. "Earlier onset of diabetes may foreshadow earlier appearance of complications," he noted.
When the HEALTHY study and its six preceding pilot studies were initially in development, he continued, "obesity rates in American youth had been climbing steadily for two decades. Then, medical centers around the country began reporting a disturbing new trend, Type 2 diabetes was increasingly being diagnosed in youths, especially black, Hispanic, and American Indian adolescents. By 1999, some pediatric centers, especially those in inner cities, were seeing more new cases of Type 2 diabetes than Type 1. We needed to find ways to contain the rising rate of Type 2 diabetes in kids, and schools were a logical place to start."
Dr. Cynthia L. Ogden (Centers for Disease Control and Prevention, Atlanta, GA), also on hand at the briefing but not a HEALTHY study researcher, showed 2007/08 data from the National Health and Nutrition Examination Survey suggesting that 31.7% of US children aged two to 19 are overweight or obese, amounting to 23.4 million children. Among them, she said, are the 17% of US kids in that age group, a total of about 12.5 million, who qualify as obese.
Also, Rodgers said, the HEALTHY pilot trials suggested that up to 40% of eighth graders at schools with high-risk populations had elevated fasting glucose levels. "So the question became, can changes in schools -- namely, longer and more intense gym classes, healthier food choices, and classroom activities that promote healthy behavior -- lower risk factors for Type 2 diabetes in youth?"
The program consisted of interventions grouped in four domains. (Details and the materials used are available on the study's website.) The nutritional component called for healthy improvements in the quality and quantity of food and beverages available at the schools' cafeterias, snack bars, and vending machines, and even at fundraisers and classroom parties, according to Hirst. Available choices shifted to those lower in fat, higher in fiber, heavier on fruit and vegetables, and lower in added sugar.
The physical-activity component was aimed at increasing both participation and activity levels in physical education classes, emphasizing activities that raised the heart rate.
Dr. Kathryn Hirst (George Washington University School of Public Health, Washington, DC) provided more details of the intervention program, which consisted of "multiple components that were designed to change the school environment radically." Experts on the study's staff at its seven regional field offices provided "training, guidance, assistance, materials, and support" for instituting the program to the faculties and staff at each of the schools, "who were the ones who actually delivered the intervention," she noted.
Teachers received instruction on holding school-wide events that promoted physical activity. Minimum weekly durations of physical education classes were instituted.
The third component, focused on behavior, according to the report, promoted classroom and family-outreach activities to educate and sharpen self-awareness and decision-making, self-monitoring, and goal-setting skills consistent with the overall program.
The fourth component, communication, focused on the use of marketing techniques to promote the program's goals within the schools and establish a "brand" to characterize and identify the changes to menus and physical activities that were part of the program.
Healthy Study Group. A school-based intervention for diabetes risk reduction. New Engl J Med 2010; DOI:10.1056/NEJMoa1001933. Available at www.nejm.org.
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