Richard Kahn, PhD, who was the chief scientific and medical officer of the ADA for nearly 25 years stated at a conference that, "Community-based weight-loss programs have not been shown to be effective at reducing the incidence of diabetes, so implementing a national program would likely be money down the drain."...
He stated that, "Community programs are ineffective at achieving weight loss."
Kahn -- who now teaches medicine at the University of North Carolina at Chapel Hill -- said that just sustaining significant weight loss, even with intensive dieting, exercise, and coaching, "requires near-heroic measures" in the face of a "very hostile food environment."
He outlined his views in a published paper, in which he wrote that there are two ways to dramatically reduce the toll of diabetes: One is to detect diabetes early and then treat it so effectively that complications from the disease are practically zero. The other is to prevent diabetes before it even happens.
Thousands of public health campaigns are aimed at prevention, and for diabetes, that generally means losing weight. But people have the "fundamental problem" of not being able to maintain weight loss, so preventing diabetes in a person at high risk for the disease is extremely difficult, Kahn said.
His paper looked at diabetes prevention studies, including the large Diabetes Prevention Program, in which patients lost an average of between 4% and 6% of their body weight (but gained about 40% back by the end of the nearly three-year trial). It also looked at the government-funded Look AHEAD trial, which found that intensive lifestyle changes resulted in a major reduction in cardiovascular risk factors, but the effects greatly diminished after four years when many participants gained weight and lost their improved fitness.
Kahn said those studies, along with the Finnish Diabetes Prevention Study -- in which the greatest diabetes prevention benefit occurred in people who lost at least 5% of their body weight -- suggest that "without substantial, sustained weight loss, progression to diabetes will probably resume." Progression to diabetes may be delayed for a few years, but the long-term effects are uncertain, he said.
(However, a preliminary study presented at the American Diabetes Association meeting last year found that a short-term lifestyle modification program for overweight diabetic patients showed long-term benefits for many of the participants.)
"In sum, to date, we have not seen a demonstration of any program that results in a clinically meaningful weight loss that can be maintained for more than two to three years in the great majority of participants and at a low cost," Kahn wrote.
Kahn's remarks preceded those of Kenneth Thorpe, of Emory University, who outlined how the healthcare reform law laid the groundwork for a national, community-based diabetes prevention strategy modeled on the Diabetes Prevention Program.
Kahn said that would be a waste of money. "The main argument is that implementing a nationwide community intervention program is not going to do anything, I believe, except waste resources." He also stated that there are too many unanswered questions about how weight loss works that must be answered before a national program would ever succeed in preventing diabetes in the long term.
"We really need to know what is going on with this complex system we have," he said. "What is going on in our physiology that precludes us from losing weight and keeping it off?" Another issue that prevents people from keeping weight off is the ubiquity of the "cheap, widely available, delicious food that we eat again and again."
He suggested "painful policies" as the solution -- such as raising the price of all food except for fruits and vegetables, and offering financial incentives to people who can keep weight off, while penalizing overweight people with higher insurance premiums.
He acknowledged those aggressive policies likely would be unpopular among members of Congress and doctors. "While we wait for the time when lifestyle modification becomes practical, we might be better served by focusing more attention on improving our understanding of the processes that affect energy intake and expenditure and improving the medical management of diabetes," Kahn wrote.
Those medical management strategies include making an early diagnosis and administering "proven treatments that have been shown to reduce complications of diabetes and extend life," he said.
He added that the best doctors can offer right now is to suggest to overweight patients that losing 4% body weight and keeping it off can reduce the risk for serious complications of diabetes by 15% to 20%.
Health Affairs, Jan. 2012
Showing posts with label obesity life threatening complications. Show all posts
Showing posts with label obesity life threatening complications. Show all posts
Thursday, January 19, 2012
Friday, October 7, 2011
Hypermobile Flatfoot And Pediatric Obesity: What You Should Know
Given the increasing prevalence of childhood obesity, this author examines the emerging connection with pediatric flatfoot via a thorough review of the current research and discusses the need for further research to support treatment of flatfoot in this population.
Almost daily, you can turn on your TV or open your favorite newspaper and learn about the “national health crisis” that is obesity. There is also a tremendous amount of literature concerning the long-term health pitfalls of morbid obesity and how it can affect the heart, liver, kidney and lymphatic system. Obviously, obesity can also lead to diabetes and a whole host of other health-related issues.
We are also starting to realize that these poor habits begin in our youth and translate to our overall health as adults. This is very apparent if you’ve ever watched The Jamie Oliver Experiment. In this show, the titular young chef travels the United States and tries to revamp cafeterias in public schools to have a menu that is generally healthier, and convince our nation’s youth to modify their lifestyles and help them attain health into adulthood.
As a parent, I am very concerned about my children’s health but does their health translate to their feet as well? Are obese children more prone to a certain foot type? If that is the case, how does that relate to their general health?
A Closer Look At How Researchers Are Identifying Flatfoot In Study Populations
Before starting the discussion of flatfoot studies and their outcomes, I would like to discuss the methodologies of many of these authors with respect to how they determined a flatfoot condition. Many of the studies that I will discuss employed modern methods of determining foot type. We use many of these methods (such as weightbearing radiographic measurements and evaluation of patients in stance and ambulation) in the day-to-day practice of podiatry.
Study authors used these and other more sophisticated methods of determining flatfoot. The other methods included: electronic footprint capture during gait; ultrasonography to measure fat pad thickness; dynamic plantar pressure analysis; and three dimensional laser surface measures. It is important to point out the use of these additional measurement techniques as they lend credence to the outcomes and conclusions of the studies. Without these modalities, one might be tempted to pass off many of the conclusions derived from these studies as “user bias.” However, most of these studies also combined sophisticated measurement techniques with hard data and statistical analysis. This was one the reasons I selected these studies for this review.
Other studies throughout the world’s medical communities have found similar results when studying the relationship with childhood obesity and flatfoot. In doing the research for this article, it became evident that every corner of the world is struggling with this problem of obesity and flatfoot, given the type of research that is occurring with the pediatric population.
What The Research Says About The Effect Of Weight On Pediatric Feet
As we know, infants do not have much of an arch. Even new walkers do not display much of an arch height. Up until approximately the age of 2, when the arch becomes recognizable, it is virtually impossible to assess foot type unless significant pathology is present.
One study attempted to correlate obesity and low arch height in adults.1 The authors found, using footprint-based estimates, that study patients who were obese displayed lower arch heights than their non-obese adult counterparts. Although this study did not focus on the pediatric population, it served as a springboard for others to investigate this topic in obese children as well.
Another study in Australia measured the same basic premise of arch height in obese children.2 The authors found that “obese children had fatter and flatter feet compared to normal weight children.” They did caution, however, that more studies needed to be completed to assess “… the functional and clinical relevance of the increase [sic] … .”2
A similar study out of Spain found similar results when researchers compared the arch height of obese and non-obese children.3 The authors concluded that obese children had lower medial longitudinal arch heights. They did not, however, relate whether lower arch heights were due to a more pronounced fat pad or whether they were due to a more structurally related etiology.
Another study based in Australia also found that obese children had flatter feet.4 Researchers then postulated that this flatter foot morphology could be caused by structural changes in the anatomy of these children’s feet and the morphology can affect function as these children mature into adulthood.
Interestingly, another group of Australian researchers studied the effects of medial midfoot fat pad thickness and how it correlates to plantar pressures in school age children.5 Although the authors did find some correlation between the two factors, they also admitted that this correlation was rather low and more intense study was needed to solidify a more meaningful conclusion.
The last but potentially most telling of the research published in Australia on this topic is a study that took this concept into a more biomechanical realm than the others and examined the kinematics of gait.6 The study patients underwent analyses that measured certain aspects of their gait while they were being filmed walking. What the authors found was that obese children had more “gait asymmetry … a greater stride width … pointing to a slower, more tentative normal speed.” They also found that the obese children were more unstable at a slower walking speed and that they had trouble walking at a faster pace. Additionally, they found that obese children had a more flat-footed and abducted gait at all phases of the gait cycle.
In a study of 835 preschool age children in Austria, the authors found that the most common study group that displayed a flat-footed morphology was the obese male children.7 Researchers went so far to say they observed “a highly significant prevalence of flatfoot” in the overweight child. A study based in Italy found similar results.8 In a study of 243 children between the ages of 8 to 10 years of age, the authors found those who were obese had a higher incidence of moderate and very marked flat-footedness in comparison to their non-obese classmates.
A group in Germany chose a slightly different route to identify the feet of their patients.9 They chose to classify the feet by how they looked and found that overweight children were much more likely to have flat feet or what they called “robust” feet. They did not quantify exactly what “robust” referred to but the description of flat feet was more descriptive of the morphology of the overweight children in any case.
The Taiwanese were so interested in this phenomenon that they generated three separate studies concerning the prevalence of flexible flatfoot in obese school age children. Within these three research articles, researchers evaluated a total of over 4,700 children. This comprises the largest cumulative sample size ever seen with this topic.
The first study was comprised of 1,598 children and its conclusion was that obesity was one of the risk factors of developing this foot type.10 A study concluded one year earlier with a sample size of over 2,000 children showed that male children who were obese were 2.66 times more likely to have a flatfoot morphology than their non-obese classmates.11 The study also noted that female children who were obese were 1.39 times more likely to have this foot morphology than females who were not obese. In addition, researchers noted that obese children of either sex showed this foot morphology between the ages of 7 and 8.
The last of the Taiwanese studies published recently evaluated flatfoot in children between the ages of 5 and 13.12 Researchers found that when combining the children they considered “overweight” and “obese,” there was a very large percentage who had flat feet. Fifty-six percent of children they classified as “obese” had flat feet and 31 percent of those who were “overweight” had flat feet. The one observation with this study that one should note is that the “normal” children had a 27 percent prevalence of obesity. This calls the statistical analysis of the authors’ data into question but we cannot overlook their conclusion.
In Search Of EBM For Flatfoot Treatment In Obese Pediatric Patients
Much of the research shows that to some degree or another, obesity in childhood can lead to flatfoot. Now how do we transfer this knowledge to the care of this pediatric population?
Much of the studies talk about the foot type but few refer to the consequences of this foot type. One journal article that talks about obesity as a potential cause of flatfoot also expresses concern that one should treat this carefully and consider patient adherence and parental involvement in following the treatment plan.13
There are only two papers relating the factors of pediatric obesity, flatfoot and pain. The relationship of the three factors in these articles is not direct but the authors talk of the factors in broader terms as potential explanations for the foot type causing pain. One study discusses pediatric obesity as a potential cause for flatfoot pain via Sever’s disease.14 The other study discusses an increase in symptoms in pediatric patients with rigid flat feet if the patients were in the 95th percentile or higher in weight for their age.15 Once again, there is no literature that offers evidence to suggest a youngster who is obese will eventually become an adult with painful flatfoot.
This is where the vacuum exists. This is our biggest hurdle to overcome to begin the process of justifying the treatment of the pediatric flatfoot. Whether the flatfoot is caused by obesity, connective tissue disorders, severe equinus, compensated metatarsus adductus or the myriad of other potential causes, our next hurdle is to show that left to its own devices, this foot type will cause lasting pain and potential disability if left untreated or supported.
The biggest problem we encounter is how to design a study protocol to test this theory. It is unreasonable to expect that a study protocol would suggest having a treatment group and a control group. In such a hypothetical study, one group would wear orthotics or undergo corrective surgery to reconstruct the foot into a more “neutral” and functional foot type. The other group would just have simple observation. This study would follow the “subjects” over the course of a generation and the results would be calculated regardless of the patient’s lifestyle or job choice. The “subjects” would be followed by a group of practitioners or via a multicenter study over the course of the doctors’ careers and would only be subject to statistical scrutiny as the pediatric patients mature into their adult lives, or beginning in their late teens.
Until a project such as the one described occurs, the evidence basis to justify treatment of flatfoot in obese pediatric patients remains elusive.
Almost daily, you can turn on your TV or open your favorite newspaper and learn about the “national health crisis” that is obesity. There is also a tremendous amount of literature concerning the long-term health pitfalls of morbid obesity and how it can affect the heart, liver, kidney and lymphatic system. Obviously, obesity can also lead to diabetes and a whole host of other health-related issues.
We are also starting to realize that these poor habits begin in our youth and translate to our overall health as adults. This is very apparent if you’ve ever watched The Jamie Oliver Experiment. In this show, the titular young chef travels the United States and tries to revamp cafeterias in public schools to have a menu that is generally healthier, and convince our nation’s youth to modify their lifestyles and help them attain health into adulthood.
As a parent, I am very concerned about my children’s health but does their health translate to their feet as well? Are obese children more prone to a certain foot type? If that is the case, how does that relate to their general health?
A Closer Look At How Researchers Are Identifying Flatfoot In Study Populations
Before starting the discussion of flatfoot studies and their outcomes, I would like to discuss the methodologies of many of these authors with respect to how they determined a flatfoot condition. Many of the studies that I will discuss employed modern methods of determining foot type. We use many of these methods (such as weightbearing radiographic measurements and evaluation of patients in stance and ambulation) in the day-to-day practice of podiatry.
Study authors used these and other more sophisticated methods of determining flatfoot. The other methods included: electronic footprint capture during gait; ultrasonography to measure fat pad thickness; dynamic plantar pressure analysis; and three dimensional laser surface measures. It is important to point out the use of these additional measurement techniques as they lend credence to the outcomes and conclusions of the studies. Without these modalities, one might be tempted to pass off many of the conclusions derived from these studies as “user bias.” However, most of these studies also combined sophisticated measurement techniques with hard data and statistical analysis. This was one the reasons I selected these studies for this review.
Other studies throughout the world’s medical communities have found similar results when studying the relationship with childhood obesity and flatfoot. In doing the research for this article, it became evident that every corner of the world is struggling with this problem of obesity and flatfoot, given the type of research that is occurring with the pediatric population.
What The Research Says About The Effect Of Weight On Pediatric Feet
As we know, infants do not have much of an arch. Even new walkers do not display much of an arch height. Up until approximately the age of 2, when the arch becomes recognizable, it is virtually impossible to assess foot type unless significant pathology is present.
One study attempted to correlate obesity and low arch height in adults.1 The authors found, using footprint-based estimates, that study patients who were obese displayed lower arch heights than their non-obese adult counterparts. Although this study did not focus on the pediatric population, it served as a springboard for others to investigate this topic in obese children as well.
Another study in Australia measured the same basic premise of arch height in obese children.2 The authors found that “obese children had fatter and flatter feet compared to normal weight children.” They did caution, however, that more studies needed to be completed to assess “… the functional and clinical relevance of the increase [sic] … .”2
A similar study out of Spain found similar results when researchers compared the arch height of obese and non-obese children.3 The authors concluded that obese children had lower medial longitudinal arch heights. They did not, however, relate whether lower arch heights were due to a more pronounced fat pad or whether they were due to a more structurally related etiology.
Another study based in Australia also found that obese children had flatter feet.4 Researchers then postulated that this flatter foot morphology could be caused by structural changes in the anatomy of these children’s feet and the morphology can affect function as these children mature into adulthood.
Interestingly, another group of Australian researchers studied the effects of medial midfoot fat pad thickness and how it correlates to plantar pressures in school age children.5 Although the authors did find some correlation between the two factors, they also admitted that this correlation was rather low and more intense study was needed to solidify a more meaningful conclusion.
The last but potentially most telling of the research published in Australia on this topic is a study that took this concept into a more biomechanical realm than the others and examined the kinematics of gait.6 The study patients underwent analyses that measured certain aspects of their gait while they were being filmed walking. What the authors found was that obese children had more “gait asymmetry … a greater stride width … pointing to a slower, more tentative normal speed.” They also found that the obese children were more unstable at a slower walking speed and that they had trouble walking at a faster pace. Additionally, they found that obese children had a more flat-footed and abducted gait at all phases of the gait cycle.
In a study of 835 preschool age children in Austria, the authors found that the most common study group that displayed a flat-footed morphology was the obese male children.7 Researchers went so far to say they observed “a highly significant prevalence of flatfoot” in the overweight child. A study based in Italy found similar results.8 In a study of 243 children between the ages of 8 to 10 years of age, the authors found those who were obese had a higher incidence of moderate and very marked flat-footedness in comparison to their non-obese classmates.
A group in Germany chose a slightly different route to identify the feet of their patients.9 They chose to classify the feet by how they looked and found that overweight children were much more likely to have flat feet or what they called “robust” feet. They did not quantify exactly what “robust” referred to but the description of flat feet was more descriptive of the morphology of the overweight children in any case.
The Taiwanese were so interested in this phenomenon that they generated three separate studies concerning the prevalence of flexible flatfoot in obese school age children. Within these three research articles, researchers evaluated a total of over 4,700 children. This comprises the largest cumulative sample size ever seen with this topic.
The first study was comprised of 1,598 children and its conclusion was that obesity was one of the risk factors of developing this foot type.10 A study concluded one year earlier with a sample size of over 2,000 children showed that male children who were obese were 2.66 times more likely to have a flatfoot morphology than their non-obese classmates.11 The study also noted that female children who were obese were 1.39 times more likely to have this foot morphology than females who were not obese. In addition, researchers noted that obese children of either sex showed this foot morphology between the ages of 7 and 8.
The last of the Taiwanese studies published recently evaluated flatfoot in children between the ages of 5 and 13.12 Researchers found that when combining the children they considered “overweight” and “obese,” there was a very large percentage who had flat feet. Fifty-six percent of children they classified as “obese” had flat feet and 31 percent of those who were “overweight” had flat feet. The one observation with this study that one should note is that the “normal” children had a 27 percent prevalence of obesity. This calls the statistical analysis of the authors’ data into question but we cannot overlook their conclusion.
In Search Of EBM For Flatfoot Treatment In Obese Pediatric Patients
Much of the research shows that to some degree or another, obesity in childhood can lead to flatfoot. Now how do we transfer this knowledge to the care of this pediatric population?
Much of the studies talk about the foot type but few refer to the consequences of this foot type. One journal article that talks about obesity as a potential cause of flatfoot also expresses concern that one should treat this carefully and consider patient adherence and parental involvement in following the treatment plan.13
There are only two papers relating the factors of pediatric obesity, flatfoot and pain. The relationship of the three factors in these articles is not direct but the authors talk of the factors in broader terms as potential explanations for the foot type causing pain. One study discusses pediatric obesity as a potential cause for flatfoot pain via Sever’s disease.14 The other study discusses an increase in symptoms in pediatric patients with rigid flat feet if the patients were in the 95th percentile or higher in weight for their age.15 Once again, there is no literature that offers evidence to suggest a youngster who is obese will eventually become an adult with painful flatfoot.
This is where the vacuum exists. This is our biggest hurdle to overcome to begin the process of justifying the treatment of the pediatric flatfoot. Whether the flatfoot is caused by obesity, connective tissue disorders, severe equinus, compensated metatarsus adductus or the myriad of other potential causes, our next hurdle is to show that left to its own devices, this foot type will cause lasting pain and potential disability if left untreated or supported.
The biggest problem we encounter is how to design a study protocol to test this theory. It is unreasonable to expect that a study protocol would suggest having a treatment group and a control group. In such a hypothetical study, one group would wear orthotics or undergo corrective surgery to reconstruct the foot into a more “neutral” and functional foot type. The other group would just have simple observation. This study would follow the “subjects” over the course of a generation and the results would be calculated regardless of the patient’s lifestyle or job choice. The “subjects” would be followed by a group of practitioners or via a multicenter study over the course of the doctors’ careers and would only be subject to statistical scrutiny as the pediatric patients mature into their adult lives, or beginning in their late teens.
Until a project such as the one described occurs, the evidence basis to justify treatment of flatfoot in obese pediatric patients remains elusive.
Friday, March 4, 2011
Meal Replacements Don't Help Obese Teens
Dietetic shakes and prepackaged entrees help obese teenagers lose weight loss at first. But "meal replacements" were no better than a standard low-calorie diet for helping young people continue losing weight over the course of a year....
Dr. Robert L. Berkowitz, Children's Hospital of Philadelphia, and his team note in their report that swapping regular meals for shakes, bars or prepackaged entrees can be a useful weight loss strategy for adults.
One reason that these meal replacements may work is that they take the guesswork out of dieting; people often sharply underestimate their calorie intake when they eat regular foods. Given that adolescents also underestimate how many calories they consume, the researchers sought to investigate whether meal replacements might be helpful for them, too.
The researchers randomly assigned 113 obese teens and their families to one of three regimens for a year: (1) a standard 1,300- to 1,500-calorie-a-day diet; (2) four months of meal replacements (three SlimFast shakes, one prepackaged entrée, and five servings of fruits and vegetables per day) followed by eight months on the conventional diet; or (3) an entire year of meal replacements.
At four months, patients in the meal replacement groups had reduced their body mass index (BMI) by a mean of 6.3%, compared to 3.8% for teens in the low-calorie diet group.
But by the end of the year, there was no significant difference in mean BMI reduction between the three groups: 2.8% for the low-calorie diet group, 3.9% with four months of meal replacements, and 3.4% with a year of meal replacements.
One-third of the patients dropped out of the study. Among those who stuck with it, adherence waned as time wore on. By the end of 12 months, the researchers note, the meal-replacement group reported using SlimFast only 1.6 days a week, compared with 5.6 days a week in month two.
"The potential benefit of (meal replacement) in maintaining weight loss was not supported," the researchers conclude, and further study is needed to find ways of getting obese teens to start diets and stay on them.
Dr. Robert L. Berkowitz, Children's Hospital of Philadelphia, and his team note in their report that swapping regular meals for shakes, bars or prepackaged entrees can be a useful weight loss strategy for adults.
One reason that these meal replacements may work is that they take the guesswork out of dieting; people often sharply underestimate their calorie intake when they eat regular foods. Given that adolescents also underestimate how many calories they consume, the researchers sought to investigate whether meal replacements might be helpful for them, too.
The researchers randomly assigned 113 obese teens and their families to one of three regimens for a year: (1) a standard 1,300- to 1,500-calorie-a-day diet; (2) four months of meal replacements (three SlimFast shakes, one prepackaged entrée, and five servings of fruits and vegetables per day) followed by eight months on the conventional diet; or (3) an entire year of meal replacements.
At four months, patients in the meal replacement groups had reduced their body mass index (BMI) by a mean of 6.3%, compared to 3.8% for teens in the low-calorie diet group.
But by the end of the year, there was no significant difference in mean BMI reduction between the three groups: 2.8% for the low-calorie diet group, 3.9% with four months of meal replacements, and 3.4% with a year of meal replacements.
One-third of the patients dropped out of the study. Among those who stuck with it, adherence waned as time wore on. By the end of 12 months, the researchers note, the meal-replacement group reported using SlimFast only 1.6 days a week, compared with 5.6 days a week in month two.
"The potential benefit of (meal replacement) in maintaining weight loss was not supported," the researchers conclude, and further study is needed to find ways of getting obese teens to start diets and stay on them.
Sunday, February 6, 2011
The Growing Problem of Childhood Obesity
With childhood obesity starting at ever-younger ages, it's never too soon to educate kids about a healthy diet. Learn about creating an obesity-fighting diet for your children at home and at school. Childhood obesity is a growing problem. Figuring out how to help your children eat a healthy diet and avoid obesity may be challenging, especially in the face of favorite high-calorie snacks, finger foods, and sugary drinks. But the stakes are high: A recent study of 3,098 children between 3 and 6 years old showed that excess weight causes an increase in heart disease risk factors even in toddlerhood.
“Obesity has increased from 5 percent in the 1970s to 12.4 percent today in preschoolers ages 2 to 5. In children ages 6 to 11, it went from 4 percent to 17 percent and the 12- to 19-year-olds, from 6 to 17.6 percent,” says Leah Holbrook MS, RD, clinical instructor of family medicine and Heart Links project coordinator for the department of family medicine at SUNY Stony Brook in Stony Brook, N.Y.
It’s never too soon to stress healthy eating — recent research suggests that the trend toward obesity may begin as early as the first six months of life.
Childhood Obesity: Helping Children Lose Weight at Home
You may be tempted to turn to popular commercial diets for guidance, but Holbrook advises caution. Children and teens are still growing, so the calorie or nutrition restrictions in commercial adult diets may not be good options for younger bodies, Holbrook says. A guide to healthy diets can be found at the USDA’s My Pyramid for Kids. But if you are not sure how to apply those ideas, Holbrook advises talking to your doctor.
Holbrook offers these tips to help fight childhood obesity:
Toss the sweet drinks. Sugary drinks such as soda, sweet tea, juice, and sweetened milk are a major source of unnecessary calories in the diet. Offer plain, low-fat milk or water instead.
Eat at home more. “When you eat out, you almost always get more calories and fat than if you eat at home,” says Holbrook, who adds that there is also a lot of value in spending time together making and eating meals.
Exercise together. A family walk, bike ride, or romp in the park can help set a healthy tone for everyone. Children should have an hour of physical activity a day, says Holbrook.
Talk to kids about healthy food choices. Educate your children about healthy diet issues such as correct portion sizes and why whole-grain crackers, fruits, vegetables, and low-fat dairy snacks are better than cookies, candy bars, or potato chips — and follow through by keeping these healthy snacks available at home.
Consider other family issues. If you are struggling with stress and parenting overall, you may need to ask for help. A recent study of 2,400 toddlers and their mothers showed a 50 percent greater risk of obesity among children whose mothers who said they were often too overwhelmed to express love or make sure their child got necessary medical care.
Childhood Obesity: Helping Children Lose Weight at School
It is equally important for parents to make their concerns known at the school or daycare facility where their children eat one or more meals, plus snacks, every day. Policy changes that require healthier foods in the cafeteria and vending machines at these locations have been shown to help children control their weight, according to Holbrook.
“Parents are really integral in making these policies work. If they are not supportive of these policies, the school districts won’t pursue them. And as long as the adults are on board, the kids don’t seem to mind,” says Holbrook.
If your school system or daycare provider is slow to change, you may have to work with your child to create healthy, filling brown-bag lunch and snack options for them to take to school. But with information and support, you and your children can fight obesity.
By Madeline Vann, MPH
Medically reviewed by Christine Wilmsen Craig, MD
“Obesity has increased from 5 percent in the 1970s to 12.4 percent today in preschoolers ages 2 to 5. In children ages 6 to 11, it went from 4 percent to 17 percent and the 12- to 19-year-olds, from 6 to 17.6 percent,” says Leah Holbrook MS, RD, clinical instructor of family medicine and Heart Links project coordinator for the department of family medicine at SUNY Stony Brook in Stony Brook, N.Y.
It’s never too soon to stress healthy eating — recent research suggests that the trend toward obesity may begin as early as the first six months of life.
Childhood Obesity: Helping Children Lose Weight at Home
You may be tempted to turn to popular commercial diets for guidance, but Holbrook advises caution. Children and teens are still growing, so the calorie or nutrition restrictions in commercial adult diets may not be good options for younger bodies, Holbrook says. A guide to healthy diets can be found at the USDA’s My Pyramid for Kids. But if you are not sure how to apply those ideas, Holbrook advises talking to your doctor.
Holbrook offers these tips to help fight childhood obesity:
Toss the sweet drinks. Sugary drinks such as soda, sweet tea, juice, and sweetened milk are a major source of unnecessary calories in the diet. Offer plain, low-fat milk or water instead.
Eat at home more. “When you eat out, you almost always get more calories and fat than if you eat at home,” says Holbrook, who adds that there is also a lot of value in spending time together making and eating meals.
Exercise together. A family walk, bike ride, or romp in the park can help set a healthy tone for everyone. Children should have an hour of physical activity a day, says Holbrook.
Talk to kids about healthy food choices. Educate your children about healthy diet issues such as correct portion sizes and why whole-grain crackers, fruits, vegetables, and low-fat dairy snacks are better than cookies, candy bars, or potato chips — and follow through by keeping these healthy snacks available at home.
Consider other family issues. If you are struggling with stress and parenting overall, you may need to ask for help. A recent study of 2,400 toddlers and their mothers showed a 50 percent greater risk of obesity among children whose mothers who said they were often too overwhelmed to express love or make sure their child got necessary medical care.
Childhood Obesity: Helping Children Lose Weight at School
It is equally important for parents to make their concerns known at the school or daycare facility where their children eat one or more meals, plus snacks, every day. Policy changes that require healthier foods in the cafeteria and vending machines at these locations have been shown to help children control their weight, according to Holbrook.
“Parents are really integral in making these policies work. If they are not supportive of these policies, the school districts won’t pursue them. And as long as the adults are on board, the kids don’t seem to mind,” says Holbrook.
If your school system or daycare provider is slow to change, you may have to work with your child to create healthy, filling brown-bag lunch and snack options for them to take to school. But with information and support, you and your children can fight obesity.
By Madeline Vann, MPH
Medically reviewed by Christine Wilmsen Craig, MD
Monday, January 31, 2011
Causes of Type 2 Diabetes
Causes of Type 2 Diabetes
Eating too much and exercising too little are two of the main reasons why people develop type 2 diabetes.
By Madeline Vann, MPH
Medically reviewed by Christine Wilmsen Craig, MD Print Email Insulin is a hormone made in the pancreas that allows glucose (sugar) to leave the bloodstream and enter the cells to be used as fuel. Type 2 diabetes occurs when the pancreas doesn't make enough insulin or the cells of the body become resistant to insulin. It is not known for certain why some people develop type 2 diabetes and some do not; however, there are several factors, such as genetics, obesity, and physical inactivity, that can increase a person's risk of developing type 2 diabetes.
Type 2 Diabetes: Primary Causes
Being obese or overweight puts you at significant risk for developing type 2 diabetes. Four out of five people with type 2 diabetes are overweight or obese.
“One of the links with obesity is that fat induces a mild, low-grade inflammation throughout the body that contributes to heart disease and diabetes,” says Vivian Fonseca, MD, professor of medicine and pharmacology and chief of endocrinology at Tulane University Health Sciences Center in New Orleans.
Excess fat, especially abdominal fat, also changes the way that your body responds to insulin, leading to a condition called insulin resistance. With this condition, your cells cannot use insulin to process blood sugar out of the blood, resulting in high blood sugar levels. While not everyone with insulin resistance develops diabetes, people with insulin resistance are at increased risk of type 2 diabetes.
Type 2 Diabetes: Poor Eating Habits
Eating too much of the wrong kinds of foods can increase your risk of type 2 diabetes. Studies have shown that eating a diet of calorie-dense, refined foods and beverages, such as sodas or fruit juices, and too little raw fruits, vegetables, and whole grains can significantly increase your risk of type 2 diabetes.
Type 2 Diabetes: Too Much TV Time
An analysis of health and nutrition data from a nationally representative sample of adults between the ages of 20 and 54 years of age showed that people who watched television more than two hours a day were more likely than their peers to be obese and to have diabetes. This is probably due to snacking while watching TV. The study found that the frequent TV watchers consumed, on average, 137 more calories a day than their peers. Conversely, the data indicated that cutting TV time back to less than 10 hours a week and adding a daily 30-minute walk led to 43 percent fewer cases of diabetes in the study group.
Type 2 Diabetes: Physical Inactivity
Just as body fat interacts with insulin and other hormones to affect diabetes development, so does muscle. Lean muscle mass, which can be increased through exercise and strength training, plays a role in protecting the body against insulin resistance and type 2 diabetes. A six-month study of 117 older men and women with abdominal obesity recently demonstrated that a mix of aerobic and resistance training exercises helped to reduce insulin resistance.
Type 2 Diabetes: Sleep Habits
Sleep disturbances have been shown to affect the body’s balance of insulin and blood sugar by increasing the demand on the pancreas. Over time, this can lead to type 2 diabetes. An analysis of data from 8,992 adults who participated in the First National Health and Nutrition Examination Survey showed that over the course of a decade, those who slept fewer than five hours a night or more than nine were at increased risk of type 2 diabetes.
Type 2 Diabetes: Genetics
Genes play an important role in determining a person's risk of type 2 diabetes. Researchers have identified at least 10 genetic variations linked to increased risk for this disease. However, your genes are not your fate; diet and exercise can prevent type 2 diabetes even if you have family members with the condition.
Eating too much and exercising too little are two of the main reasons why people develop type 2 diabetes.
By Madeline Vann, MPH
Medically reviewed by Christine Wilmsen Craig, MD Print Email Insulin is a hormone made in the pancreas that allows glucose (sugar) to leave the bloodstream and enter the cells to be used as fuel. Type 2 diabetes occurs when the pancreas doesn't make enough insulin or the cells of the body become resistant to insulin. It is not known for certain why some people develop type 2 diabetes and some do not; however, there are several factors, such as genetics, obesity, and physical inactivity, that can increase a person's risk of developing type 2 diabetes.
Type 2 Diabetes: Primary Causes
Being obese or overweight puts you at significant risk for developing type 2 diabetes. Four out of five people with type 2 diabetes are overweight or obese.
“One of the links with obesity is that fat induces a mild, low-grade inflammation throughout the body that contributes to heart disease and diabetes,” says Vivian Fonseca, MD, professor of medicine and pharmacology and chief of endocrinology at Tulane University Health Sciences Center in New Orleans.
Excess fat, especially abdominal fat, also changes the way that your body responds to insulin, leading to a condition called insulin resistance. With this condition, your cells cannot use insulin to process blood sugar out of the blood, resulting in high blood sugar levels. While not everyone with insulin resistance develops diabetes, people with insulin resistance are at increased risk of type 2 diabetes.
Type 2 Diabetes: Poor Eating Habits
Eating too much of the wrong kinds of foods can increase your risk of type 2 diabetes. Studies have shown that eating a diet of calorie-dense, refined foods and beverages, such as sodas or fruit juices, and too little raw fruits, vegetables, and whole grains can significantly increase your risk of type 2 diabetes.
Type 2 Diabetes: Too Much TV Time
An analysis of health and nutrition data from a nationally representative sample of adults between the ages of 20 and 54 years of age showed that people who watched television more than two hours a day were more likely than their peers to be obese and to have diabetes. This is probably due to snacking while watching TV. The study found that the frequent TV watchers consumed, on average, 137 more calories a day than their peers. Conversely, the data indicated that cutting TV time back to less than 10 hours a week and adding a daily 30-minute walk led to 43 percent fewer cases of diabetes in the study group.
Type 2 Diabetes: Physical Inactivity
Just as body fat interacts with insulin and other hormones to affect diabetes development, so does muscle. Lean muscle mass, which can be increased through exercise and strength training, plays a role in protecting the body against insulin resistance and type 2 diabetes. A six-month study of 117 older men and women with abdominal obesity recently demonstrated that a mix of aerobic and resistance training exercises helped to reduce insulin resistance.
Type 2 Diabetes: Sleep Habits
Sleep disturbances have been shown to affect the body’s balance of insulin and blood sugar by increasing the demand on the pancreas. Over time, this can lead to type 2 diabetes. An analysis of data from 8,992 adults who participated in the First National Health and Nutrition Examination Survey showed that over the course of a decade, those who slept fewer than five hours a night or more than nine were at increased risk of type 2 diabetes.
Type 2 Diabetes: Genetics
Genes play an important role in determining a person's risk of type 2 diabetes. Researchers have identified at least 10 genetic variations linked to increased risk for this disease. However, your genes are not your fate; diet and exercise can prevent type 2 diabetes even if you have family members with the condition.
Friday, January 28, 2011
In U.S., Obesity Afflicts Even Some of the Tiniest Tots
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.
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.
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."
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