Childhood Obesity and Diabetes

The First Line Of Defense Is For Kids To Eat Right And Exercise

From http://msnbc.com/news/TODAY_front.asp
Dr. Ileana Vargas talks to "Today" host Katie Couric.

January 29, 2003 — In part four of a special series on “Today,” we look at the consequences of childhood obesity. Diseases like type 2 diabetes, once only found in adults, are now being diagnosed at an alarming rate in children as young as 10 and 12. And along with the physical ailments, comes mental anguish and stress, as overweight children struggle with peer pressure, self-image and trying to make healthy choices. Dr. Ileana Vargas is a pediatric endocrinologist at the Children’s Hospital of New York Presbyterian and she offers some insight and advice for parents.

There are many medical repercussions to childhood obesity, but clearly, it is type 2 diabetes that is setting off alarm bells and needs to be addressed now.

Type Two Diabetes:
We didn’t hear much about type 2 diabetes in children until 1997, and even then, the numbers were small. It seemed inconceivable that children would have type 2 diabetes, which is usually diagnosed in adults in their 40s.
In part because it has caught the medical community by surprise, there are very few statistics on how many children have type 2 diabetes. We do know that of all people — adults and children — diagnosed with diabetes, 50 percent have type 2. It used to be that of all those with diabetes, only 10 percent had type 2. As you know, you are born with type 1, type 2 is the result of poor diet, not enough exercise. As we see a rise in childhood obesity, there has also been a rise in type 2 diabetes.
It used to be more common in children of Hispanic or African American descent. Females were more prone to type 2 than boys. Now we are diagnosing children from all ethnic groups, and there are as many boys as girls.

What Is It:
The body produces insulin to keep blood sugar levels normal. At some point, the body can’t produce enough insulin, doesn’t use insulin properly and becomes what is called “insulin resistant.” When this happens, blood sugar levels skyrocket.
Ninety percent of children diagnosed as insulin resistant run the risk for developing type 2.

Early Warning Signs:
 * Cholesterol: Testing cholesterol is tricky because levels can test normal. But with type 2 diabetes, the good cholesterol (LDL) is usually too low, and the bad cholesterol (HDL), and triglycerides are usually elevated. As a result, the overall cholesterol level can appear normal. The two cholesterols need to be tested separately.
* Growth charts: If a child is off the charts in weight and sometimes height, or makes dramatic jumps in weight, this is a red flag.

Symptoms:
Children may show all or some of these symptoms:
 * High blood sugar levels: in the 400s, while normal would be 70-120.
 * Very thirsty, drinking a lot.
 * Urinating a lot
 * Feeling weak
 * Skin color — darkening of the skin at the base of the neck, in the folds of the arms, or around the eyes, (sometimes referred to as a “mask”)
 * Unhealed scars: They don’t heal well, have boils, unhealed mosquito bites.

Consequences:
The difference between type 1 and type 2 is that if someone has type 1 and doesn’t take care of themselves, they get sick immediately and may end up in the hospital that same day. With type 2, a person can go 10, 15 years without taking proper care of themselves, and only then show serious effects.
 *If you are 45 when you get type 2 diabetes, which used to be called “Adult onset” diabetes for just that reason, you will suffer the consequences listed below when you are 55, 60. If you are 10, 15 years old, you are at risk for these consequences when you are 20, 25 years old, in your prime child bearing years and workforce years. The societal repercussions are mind boggling. Our healthcare system will be overwhelmed.
 *When children come in with sky high blood sugar levels, the decision to send them home is a difficult one. With an adult, you can tell them to change diet, exercise, and check their levels in a week, hoping they go down. With children, it’s risky because you don’t know if they understand the seriousness. So you often have to admit them and start them on insulin.
 *High blood pressure: Who would have ever thought we’d see the day when doctors would be prescribing hypertension medication to children, some of which has only been tested on adults.
 *Early cardiovascular disease
 * Kidney failure
 * Eye changes that can lead to blindness.

Difficulties In Treating Children:
Kids don’t want to deal with this, and because they don’t end up in the hospital like people with type 1, it can go on and on without being treated. They don’t understand how important the diet and exercise is. It’s very difficult for young children and teens to understand high blood sugar levels. But mostly, it’s unrealistic to expect them to make the right decisions about what goes in their bodies when healthy choices are few and far between.

Prevention:
Diet and exercise. It seems so simple, but clearly the message isn’t getting out because there are so many obese children and children with diabetes.
 * It may be too late to help teenagers or even junior high kids who have developed type 2. They may well have to deal with it their entire lives.
 * There is hope for the younger kids though. Children in grammar school can still make the lifestyle changes needed if we start working on it now.

Helping Kids Make Healthy Choices:
Don’t expect kids to make the right decisions about health if they don’t have the education to do so, and they don’t have healthy options to choose from.
The first line of defense is for kids to eat right and exercise. The ultimate responsibility lays with the parent, but there are changes that need to be made in the schools.

School Lunches:
 * Cafeterias: It’s difficult for a child to turn down the hamburger and fries and greasy pizza from the cafeteria if the only other alternative is wilted salad that no one eats and has been sitting around for two days.

Vending Machines:
 * Unhealthy choices: They should not be allowed in schools. Kids should have a choice between an apple, a pear, and a banana as a snack. Not between a hostess donut, chips, and sodas.
 * Money for schools: We are selling out our kids health. Schools get money from the soda companies when they allow them at the schools. Schools need to come up with more creative ways to raise funds. Kids are spending the money they bring to school. Schools need to sell something else, like knick knacks, pencils, pens, things they like to use. There are big pushes in NY and all over the country to rid schools of vending machines. The problem is, school funding is being cut, and this is a way for them to raise money and buy computers, pay for after school programs. And most parents are unaware that the schools get money back from the sales from vending machines.
 * In NY Mayor Bloomberg is working to have vending machines removed from schools. In some schools it has been successful. But it needs to go hand in hand with education and teaching children what good choices are.
One suggestion from Vargas is that the price of water be lowered. A lot of kids don’t like the idea of paying for water, so maybe make water 25 or 50 cents cheaper than sodas.

Fast Food In Schools
 * Same as with vending machines. Schools get a break or money back for offering McDonald’s Burger King, Dominos Pizza. This may change though after a February survey by the Children’s Health fund nationwide. They will ask parents what they think about fast food in schools and how they would react if fast food was removed.

Physical Education
 * Gym requirements have dropped drastically. Up until 5th grade, 50 percent of schools had a PE requirement. By 12th grade, that drops to only two percent.

Dr. Ileana Vargas is a pediatric endocrinologist at the Children’s Hospital of New York Presbyterian. She works with overweight children one on one and in groups and is also working with schools to help with the prevention of obesity and diabetes, and to try and get vending machines out of schools.