Chewing the Fat: A Troubling Trend in Diabetes

By Naomi Mendelsohn

Almost all the patients with type 2 diabetes and obesity have horrible dietary habits. They drink industrial amounts of soda every day. They eat high-fat fast foods.

It's no secret that Americans are getting fat. Newspaper and magazine headlines regularly ring out the weighty tidings: The Associated Press recently reported 29 Percent of Nebraska's Population Is Obese while Harper's Magazine prominently featured an article entitled Let Them Eat Fat.

According to recent studies, one fifth of all Americans have a body mass index (BMI) over 30 which means that they are not just overweight, they are obese. The scary thing is that these rates are even higher for American children. One in four Americans under the age of 19 are overweight or obese.

What this translates into are increased health risks and more and more cases of kids developing chronic illnesses such as adult-onset, or type 2, diabetes.

"There are some genetic defects that cause people to develop type 2 diabetes," explains Irene Sills, M.D., co-director of pediatric endocrinology at the Albany Medical Center(NY). "But the majority of kids with type 2 diabetes are obese. The increasing incidence of type 2 diabetes is felt to be secondary to the rise in childhood obesity."

In the past only 1 to 2 percent of children with diabetes were diagnosed with type 2 or other forms of diabetes, according to a consensus statement from the American Diabetes Association (ADA). Recent reports, however, indicate that between 8 and 45 percent of children with newly diagnosed diabetes have type 2 diabetes. Of those, 85 percent are overweight or obese.

"When people are overweight, they develop resistance to insulin," explains Dr. Sills. "The pancreas must make more insulin to keep the blood sugar normal. Eventually, the resistance wins out and the insulin cannot keep the blood sugar normal, [hence]diabetes develops."

In many cases obesity and, in turn, diabetes are directly related to diet.

"Almost all the patients with type 2 diabetes and obesity have horrible dietary habits," says Luigi Garibaldi, M.D., medical director of the Joslin Diabetes Center Youth Division at Saint Barnabas Ambulatory Care Center in Livingston (NJ). "They drink industrial amounts of soda every day. They eat high-fat fast foods. Most of the time there is obesity in their families. The dietary habits which the children develop are the same bad habits their parents have."

Because this lifestyle factor is hard to ignore, it would make sense to implement preventive nutrition programs for at-risk populations. Before there can be programs, however, there have to be studies. And, according to Dr. Garibaldi, there is little funding and little interest on the part of the government.

"States don't want to spend a lot of money for these studies," says Garibaldi. "We end up doing a lot of therapy after the fact, when it's too late."

Although physicians and scientists understand the mechanism of the disease itself, they are still trying to figure out who will be affected and, more importantly, why.

"Children of non-European origin are more susceptible to type 2 diabetes, and this probably relates to genetics," Dr. Sills says. "There is a theory about type 2 diabetes that talks about how indigenous people had to develop compensatory mechanisms for withstanding fasts and utilizing large quantities of food when they had it available. When you overfeed these populations continually, you end up with diabetes because they have not evolved to handle eating this way."

According to the National Institute for Diabetes and Digestive and Kidney Diseases, the "thrifty gene" theory proposes that African-Americans, Hispanic-Americans, Asian Americans and Native Americans inherited a gene from their ancestors which enabled them to use food more efficiently during "feast and famine" cycles. Today there are fewer such cycles; this causes certain populations to be more susceptible to obesity and to developing type 2 diabetes.

While researchers investigate this and other theories about at-risk populations, the facts remain. 27 percent of Mexican-American girls between the ages of five and 11 are obese. By fourth grade, those numbers have skyrocketed: the rate for girls is 32 percent while boys weigh in at 43 percent.

Dr. Garibaldi sees similar trends in his young patients.

"Most of my type 2 patients are from Newark Beth Israel Hospital," says Dr. Garibaldi. "They represent an urban minority population."

Aside from obesity, the other major risk factor in developing type 2 diabetes is genetics.

"It [diabetes type 2] tends to occur in multiple generations of the same family," explains Edward Horton, M.D., professor of medicine at Harvard Medical School and director of clinical research at Joslin Diabetes Center in Boston (MA). "Several members will develop diabetes. If you have the genetic disposition and then you are in a situation with certain environmental factors, particularly obesity, it will bring out diabetes in a greater percentage of people."

And Dr. Horton would know. He is the principal researcher in a five-year long study of high-risk populations to determine whether diabetes type 2 can be prevented with lifestyle changes and/or certain medications.

"We're just hoping that with a healthy diet, weight loss and an increase in physical activity, we'll prevent people at high-risk from developing diabetes."

The study, which began in 1997, has recruited 3600 people nationwide and is specifically targeting people at high risk — people who have a family member with diabetes and people from minority groups. While Dr. Horton acknowledges that this study is geared towards adults, he explains, "there's no reason that it wouldn't apply to children."

Dr. Horton's research may eventually have an impact on kids at risk of developing diabetes type 2. In the meantime, physicians like Dr. Sills and Dr. Garibaldi must treat children with the existing strategies — diet, exercise and medication.

"We try to change their diet to a sensible diet," says Dr. Garibaldi. "We don't always restrict calories, we just have them abandon a pattern of drinking juice and soda and cut down on fast foods."

It may sound easy, but kids sometimes prove a tough crowd.

"It's difficult because these habits have been continuing for many years," explains Dr. Garibaldi. "And their parents don't want to change their habits. This makes it impossible for the children to change."

And inner-city kids face even further obstacles.

"There are not too many exercise programs for children," explains Dr. Garibaldi. "We're developing one here at St. Barnabas, but it's more for a suburban population. A lot of the children have problems coming to a suburban area because of a lack of transportation. Besides that, they cannot even walk the streets because they are worried about their safety. Their activities are very, very limited."

Although there seem to be many hurdles in understanding and treating every aspect of this "new" disease, some people are reaching out to at-risk communities.

The African-American program of the ADA has started a church-based grassroots diabetes awareness program called Diabetes Sunday. In the three years since the program's inception, nearly 1.5 million people have been helped.

While this program is reaching out to families, other people are trying to reach out directly to children. Dr. Thomas Robinson, a Stanford University pediatrics professor is developing a program for young African-American girls which incorporates elements of traditional African dancing in order to make exercise more pertinent to their lives. If Dr. Robinson is successful, si

Naomi Mendelsohn is a content editor at savvyHEALTH.com.


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