Overweight families unaware & unconcerned about risk of diabetes and premature heart disease

Jun 5 2004

Two new studies show that many children are at high risk for diabetes and premature heart disease, according to British and U.S. reports here today at the American Diabetes Association's 64th Annual Scientific Sessions.

The British study found that most of the parents of obese children were unaware that their children's weight was above normal. "When parents do not recognize overweight and obesity in their children -- as up to three-quarters of the parents in our survey did not -- we are missing critical partners in our effort to halt a developing epidemic of childhood type 2 -- a form of diabetes that we once saw only in older adults," said Alison N. Jeffery, MSc, Senior Research Nurse on the Early Bird Survey at Derriford Hospital, Peninsula Medical School, Plymouth, United Kingdom in a recent interview.

In the American survey, a surprising and disturbingly large number of children in the eighth grade were found to have a cluster of problems that puts them at high risk for serious health consequences. "Our survey of 1,700 eighth grade children in Texas, North Carolina and California found that more than half had one or more problems -- such as being overweight or having cholesterol, blood pressure or blood glucose abnormalities -- that place them at high risk for diabetes and premature cardiovascular disease unless improved nutrition and increased physical activity reverse their risks," said Francine Kaufman, MD, head of the Center for Diabetes and Endocrinology, Children's Hospital of Los Angeles, and Chair of the Studies to Treat or Prevent Pediatric Type 2 Diabetes Study Group (STOPP-T2D).

More than 18 million Americans have diabetes, a group of serious diseases characterized by high blood sugar levels that result from defects in the body's ability to produce and/or use insulin. Diabetes can lead to severely debilitating or fatal complications, such as heart disease, blindness, kidney disease and amputations. It is the fifth leading cause of death by disease in the U.S. The British Early Bird Study, which started four years ago, is following a randomly selected group of 300 children and their families for 12 years, starting at an average age of 4.9 years.

The study does not try to modify their behavior or attitudes. Rather, it simply observes and measures. The children and their families visit the hospital every six months for a series of tests measuring body composition, BMI (a measure of height vs. weight, used to calculate overweight and obesity), metabolic rate, physical activity, fasting blood sugar and other parameters. Participants also answer self- perception questionnaires -- verbal for parents, pictorial for children. "Although the participants in the study are far heavier than ideal, they are unfortunately representative of the United Kingdom population," said Ms. Jeffery. Few children recognized their own BMI category, and significantly more underestimated (51 percent) than overestimated (17 percent) their weight.

One-third of mothers and half the fathers who were either overweight or obese rated themselves "about right." Further, one-third of obese girls and half of the obese boys also were rated by their parents as weighing "about right." Neither social class, level of parental education, nor family income was related to BMI, whether actual or perceived. "When the weight that physicians know to be hazardously overweight is considered normal weight by the general public, major health problems are on the horizon," said Ms. Jeffery. "Recognizing excess weight is the essential first step in health promotion, including the prevention of diabetes." Funded by the National Institute of Diabetes & Digestive & Kidney Diseases, the STOPP-T2D is a major multi-center clinical trial.

The goal is to determine whether a school-based, population-based, multi-pronged program can effect behavior change and help stop the epidemic of overweight and other risk factors for diabetes and cardiovascular disease. Results of the pilot study reported today simply determined the prevalence of those risk factors in a sample of 1,700 children -- 52 percent Hispanic, 23 percent African American, 15 percent Caucasian, three percent Native American, and 10 percent from other ethnic groups.

Students with an average age of 13.6 years were asked to report to school in the morning in a fasted state (nothing but water since bedtime the night before). Height, weight, waist circumference and blood pressure, among other parameters, were measured. Blood was drawn for analysis of glucose levels, insulin and lipids (such as cholesterol).

Overall, 49.3 percent of children had a BMI above the 85th percentile for their age and gender. Further, 40.2 percent had pre-diabetes, a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. (Pre-diabetes is defined by a fasting glucose of >100 mg/dL, whereas a diagnosis of diabetes requires a fasting glucose of >126 mg/dL.) Some cases of diabetes, hypertension and elevated cholesterol and other lipids were also found in these eighth graders.

"The prevalence of pre-diabetes and other premature heart disease risks was higher than we expected," reported Dr. Kaufman. "We look forward to implementing a three-year program that will assess the benefits of improving the school environment in nutrition and physical activity and generating behavior change in students in those areas outside of school as well," she explained. A key component of the program, which will be undertaken in seven centers, will be a "social marketing campaign" to change perceived norms among the youngsters at a key period of values-formation as they enter adolescence.

The American Diabetes Association is the nation's leading voluntary health organization supporting diabetes research, information and advocacy. Founded in 1940, the Association has offices in every region of the country, providing services to hundreds of communities. For more information, please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit http://www.diabetes.org. Information from both these sources is available in English and Spanish.