Diabetes Risk in Youth Studied
As schools across the nation have reopened their doors this fall, hundreds of sixth graders in 42 middle schools will begin taking part in a study sponsored by the National Institutes of Health (NIH).
The HEALTHY study will determine if changes in school food services and physical education (PE) classes, along with activities that encourage healthy behaviors, lower risk factors for type 2 diabetes, an increasingly common disease in youth.
“The alarming rise in obesity and type 2 diabetes in all age groups poses a major public health crisis for this country,” says NIH Director Dr. Elias A. Zerhouni.
“This important study is one component of a multi-faceted research agenda to address this dual epidemic, which threatens the health of our youth and the vitality of our health care system,” says Dr. Zerhouni.
Nearly 21 million people in the US - 7 percent of the population - have diabetes. It is the most common cause of blindness, kidney failure, amputations in adults, and a major cause of heart disease and stroke.
Type 2 diabetes accounts for up to 95 percent of all diabetes cases in adults, and about one-third of those affected do not know they have it.
The prevalence of type 2 diabetes has risen dramatically in the last 30 years, due mostly to the upsurge in obesity.
In addition, at least 54 million US adults age 20 and older have prediabetes, which independently raises the risk of developing type 2 diabetes and cardiovascular disease.
In the new study, participating schools will be randomly assigned to a program group, which implements the changes, or to a comparison group, which continues to offer food choices and PE programs typically seen in middle schools across the country.
Students in the program group will have healthier choices from the cafeteria and vending machines (e.g., lower fat foods, more fruits and vegetables, and drinks with no added sugar).
They will also have longer, more intense periods of physical activity, and activities and awareness campaigns that promote long-term healthy behaviors.
After two and one-half years, all students will be tested for diabetes risk factors, including blood levels of glucose, insulin, and lipids. They will also be measured for fitness level, blood pressure, height, weight, and waist circumference.
“The school environment can have a profound effect on the behavior and health of young people,” says Gary Foster, Ph.D., of Temple University in Philadelphia, Penn.
“From this study we hope to learn if better food options, improvements in physical activity programs, and education about eating better and moving more result in healthier kids and a lower risk of type 2 diabetes,” says Dr. Foster.
In planning the HEALTHY study, researchers relied on the results of six pilot studies. In one such study, about half of eighth graders in 12 schools were overweight or at risk for overweight.
Few had diabetes, but about 41 percent had abnormally high readings of fasting blood glucose, pointing to a much higher risk of developing type 2 diabetes.
Type 2 diabetes is closely linked to being overweight, inactive, and having a family history of diabetes.
Nearly two-thirds of US adults are overweight or obese, with a body mass index (BMI) of 25 or more.
Among youth ages 2 to 19 years old, 17 percent are overweight (i.e., have a BMI at the 95th percentile or more for their age and sex) - triple the rate in 1980.
About the same percentage of youth have a BMI between the 85th and 95th percentile for their age and sex, putting them at risk for becoming overweight.
In contrast, type 1 diabetes, which affects up to 1 million people in the US, develops when the body's immune system destroys the insulin-producing beta cells of the pancreas.
This form of diabetes usually strikes children and young adults, who need several insulin injections a day or an insulin pump to survive.
The HEALTHY study is aimed at preventing type 2 diabetes. Other NIH-funded studies are trying to prevent type 1 diabetes in centers nationwide.
The longer a person has diabetes, the greater the chances of developing serious damage to the eyes, nerves, heart, kidneys, and blood vessels.
Once seen only in adults, type 2 diabetes has been rising steadily in youth.
“We're already seeing kids in their late teens with early complications from type 2 diabetes,” says Dr. Francine Kaufman, at Childrens Hospital Los Angeles. Type 2 diabetes accounts for more than 20 percent of new childhood diabetes cases at the center.
“As a society, we need to address the obesity epidemic if we’re going to have any success containing the rising rate of type 2 diabetes in kids,” notes Dr. Kaufman. “A logical place to start is in our schools.”
While there are no national data on the prevalence of type 2 diabetes in youth, clinics around the country are reporting that more young people, especially from minority groups, are developing the disease.
Studies in Cincinnati, Los Angeles, San Antonio, and other cities conclude that cases of type 2 diabetes in youth have risen dramatically since 1994, when less than 5 percent of new childhood diabetes cases were type 2.
By 1999, type 2 diabetes accounted for 8 to 45 percent of new childhood diabetes cases, varying by geographic location. Some diabetes centers are now seeing more new cases of type 2 diabetes than type 1.
Results from the HEALTHY study are expected in 2009.
Sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the study is part of a broad research initiative, called STOPP T2D (Studies to Treat or Prevent Pediatric Type 2 Diabetes), which seeks to improve the treatment and prevention of type 2 diabetes in youth.
The American Diabetes Association (ADA) co-sponsors the HEALTHY study, and the Institute for Public Health and Water Research supports the study through a grant to the ADA.
Always consult your physician for more information.
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Overweight and obesity together represent the second leading preventable cause of death in the US.
Obesity is a serious, chronic disease that can inflict substantial harm to a person’s health.
Overweight and obesity are not the same; rather, they are different points on a continuum of weight ranging from being underweight to being morbidly obese.
The percentage of people who fit into these two categories, overweight and obese, is determined by Body Mass Index (BMI).
The US Surgeon General has declared that overweight and obesity have reached epidemic proportions in this country.
Fifteen percent of children between the ages of six and 19 are overweight. Public health officials say physical inactivity and poor diet are catching up to tobacco as a significant threat to health.
Currently, about 33 percent of women and 28 percent of men are considered seriously overweight. Obesity is a serious, chronic disease that can inflict substantial harm to a person's health.
BMI is a measure of weight proportionate to height. BMI is considered a useful measurement of the amount of body fat.
Occasionally, some very muscular people may have a BMI in the overweight range. However, these people are not considered overweight because muscle tissue weighs more than fat tissue.
Generally, BMI can be considered an effective way to evaluate whether a person is overweight or obese.
According to the National Heart, Lung, and Blood Institute (NHLBI), a BMI from 18.5 to 24.9 is considered normal while a BMI of more than 25 is considered overweight.
A person is considered obese if the BMI is greater than 30 and morbidly obese if the BMI is 40 or greater. In general, after the age of 50, a man’s weight stabilizes and even drops slightly between the ages of 60 and 74.
However, a woman’s weight continues to increase until age 60 and then begins to drop.
Another measure of obesity is the waist-to-hip ratio (WHR). The WHR is a measurement tool that looks at the proportion of fat stored on the waist, and hips and buttocks.
The waist circumference indicates abdominal fat. A waist circumference over 40 inches in men and over 35 inches in women may increase the risk for heart disease and other diseases associated with being overweight.
In many ways, obesity is a puzzling disease. How the body regulates weight and body fat is not well understood. On one hand, the cause appears to be simple in that if a person consumes more calories than he or she expends as energy, then he or she will gain weight.
However, the risk factors that determine obesity can be a complex combination of genetics, socioeconomic factors, metabolic factors, and lifestyle choices, as well as other factors.
Some endocrine disorders, diseases, and medications may also exert a powerful influence on an individual’s weight.
Factors which may influence the occurrence of obesity include:
genetics - Studies have shown that a predisposition toward obesity can be inherited. The chance of being overweight increases by 25 percent if one or both parents are obese.
Where a person carries weight - the hips or around the middle - is also strongly influenced by heredity.
metabolic factors - How a particular person expends energy is different from how someone else’s body uses energy. Both metabolic and hormonal factors are not the same for everyone, but these factors play a role in determining weight gain.
Recent studies show that levels of ghrelin, a peptide hormone known to regulate appetite, and other peptides in the stomach, play a role in triggering hunger and producing a feeling of fullness (satiety).
socioeconomic factors - There is a strong relationship between economic status and obesity, especially among women. Women who are poor and of lower social status are six times more likely to be obese than women of higher socioeconomic status.
The occurrence of obesity is also highest among minority groups, especially among women. Seventy seven percent of African-American women 20 years old or older are overweight.
lifestyle choices - Overeating, along with a sedentary lifestyle, contributes to obesity. These are lifestyle choices that can be affected by behavior change.
Eating a diet in which a high percentage of calories come from sugary, high-fat, refined foods promotes weight gain. And, as more US families eat on the go, high-calorie foods and beverages are often selected.
Lack of regular exercise contributes to obesity in adults and makes it difficult to maintain weight loss. In children, inactivity, such as watching television or sitting at a computer, contributes to obesity.
Consult your physician with questions regarding healthy body weight.
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