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Dia-besity--breaking the cycle.

"In the last 10 years alone, the number of children diagnosed with type 2 diabetes has increased several fold," notes pediatric endocrinologist R. Ravi Shankar, a researcher at the Indiana Center for Vascular Biology and Medicine (ICVBM) and one of the directors of the type 2 diabetes clinic at the Riley Hospital for Children in Indianapolis. "A decade ago, we rarely diagnosed type 2 diabetes in children and teens. Now, we are seeing an epidemic increase in the incidence of type 2 diabetes in youth. The jump is phenomenal."

Few debate the cause of the increased incidence of type 2 diabetes among America's youth and adult populations--the twin health hazards of obesity and a sedentary lifestyle. Unfortunately, surveys suggest that the trend shows no signs of slowing. Dr. Shankar notes that almost 100 percent of type 2 diabetes patients in his clinic are obese.

In the past, type 2 diabetes was called "adult-onset" diabetes because the disease rarely surfaced in the young. Combating the notion that type 2 diabetes is an "adults only" disease is a formidable task, and success in large part rests in educating parents, children, and primary care physicians about the role of obesity and sedentary lifestyle in the development of the disease.

"If a parent has a question about whether their child's weight is appropriate for his height, they should take their child to their pediatrician, who can make that determination," says Dr. Shankar. "Obesity is one very important risk factor. Acanthosis is another. The condition signals insulin resistance and appears as dark, velvety patches of skin around the neck and armpits of the patient. These patches result from elevated levels of insulin in obese individuals who are insulin resistant. When a person becomes insulin resistant, the body compensates by making more insulin. While this increased production delays the development of diabetes for as long as it can, eventually diabetes does develop in many."

If a child is overweight or obese, belongs to a minority population at increased risk for developing the disease--African-American, Hispanic, Asian Indian, or other Asian descent--or has a strong family history, he or she is at a dramatically increased risk for type 2 diabetes.

"It is very important to screen children at high risk every two years as recommended by the American Diabetes Association," stresses Dr. Shankar.

Fasting plasma glucose (sampled after a 10- to 12-hour fast) is the recommended test.

Physicians are vital links in addressing the health impact of obesity, but in some cases, pediatricians advised parents concerned about their child's weight that he or she was simply "going through a phase."

"That is a dangerous statement," says Dr. Shankar, who, with colleagues at ICVBM, is investigating the potential connection between metabolism and vascular function. "We need to diagnose obesity in its early stages. While it was once thought that obese children did not have the same health risks as obese adults, we now know that is not true. This is not puppy fat that will go away. Obesity is not benign. It is dangerous. Besides the social issues, obese children are at immediate risk of high blood pressure, lipid abnormalities, metabolic syndrome, and sleep apnea."

For concerned parents, Dr. Shankar suggests asking the family pediatrician to monitor the child's body mass index (BMI), a number that shows body weight adjusted for height.

"Follow a child's height and weight, calculate the BMI, and plot it on the BMI chart in the medical record, then follow its progression," Dr. Shankar advises. "If your child's BMI reaches the 85th percentile, it is time to start intervening aggressively."

For Dr. Shankar, the key issue is prevention. "Diabetes is a family affair," stresses Dr. Shankar. "The family's practices and beliefs led to the obesity in the first place, and changes in the family practices and beliefs can make a significant difference."

Adopting a healthier active lifestyle is the best defense.

"Exercise has an excellent effect on insulin sensitivity, blood pressure, cholesterol levels--even without major changes in weight," says Dr. Shankar. "If a person actually loses weight by exercising, it would amplify the effect of exercise. I prescribe exercise therapy to all my children. It doesn't have to be an organized activity or anything fancy. They can simply put on a CD and dance at home for 45-60 minutes every day."

Cuts in school budgets have hit physical education programs, but the push to reinstate PE programs is gaining momentum.

"Schools should make physical education compulsory throughout the schooling period," adds Dr. Shankar. "By investing in a PE program with 40-45 minutes every day of physical activity, we can make a serious investment in the health of our nation's youth."

Editor: Keith L. March, M.D., Ph.D. Director, Indiana Center for Vascular Biology and Medicine

Research is the key to discovering better ways to care for patients and improve their quality of life. For information about making a tax-deductible gift, contact Dr. March at 317278-0130, or e-mail: ICVBM's Web site is:
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Article Details
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Author:March, Keith L.
Publication:Medical Update
Geographic Code:1USA
Date:Apr 1, 2004
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