Modern life spawns twin menace to children
By Anita Manning, USA TODAY
A decade ago, a child with type 2 diabetes would be such a rarity that the case probably would be written up in a medical journal, says pediatric endocrinologist Francine Kaufman. Today, such children fill her clinic at Children's Hospital in Los Angeles.
The twin epidemics of diabetes and obesity in children and young adults have created an international public health problem, she says. To stop it, "we need to redefine progress."
Americans see progress "in terms of the quantity rather than the quality of our food," she writes in Diabesity (Bantam, $27), a book whose name expresses the link between diabetes and obesity.
"We've also defined progress as the elimination of any requirement for physical activity in our jobs and for transportation, ignoring its importance for our health.
"And thanks to this brand of 'progress,' we've managed to devise a world designed to kill us."
If there were no obesity, type 2 diabetes, the most common form of the disease, would be rare, she says. Instead, more than 18 million Americans have it. Another 41 million are pre-diabetic, with blood sugar levels higher than normal.
"This generation of children growing up may be the first to live shorter lives than their parents," Kaufman says.
More children are seriously overweight than ever, Kaufman says, and that is leading to type 2 diabetes, which until recent years was thought to occur only in middle age or later. Because they're getting diabetes early, these children risk suffering its complications early in life, she says.
Of the estimated 18 million Americans with diabetes, 5.2 million are not diagnosed. Untreated, the disease silently damages blood vessels and organs. The Centers for Disease Control and Prevention estimates that men who have diabetes before age 40 lose more than 11 years of their expected life span; women lose more than 14 years.
"Diabetes is not a little bit of a problem. It's a huge problem for the people who have it," she says. "If they don't address it, they're destined to take layer on layer of medications and still risk losing their eyesight or limbs or having a heart attack or stroke."
It's society's problem, too, she says. Diabetes consumes one of every seven health care dollars; it cost $92 billion in 2002. Add in lost wages and productivity, and the bill comes to $137.7 billion, she says.
Kaufman recommends specific actions, such as getting soft drinks and unhealthful snacks out of school vending machines; limiting children to two hours a day in front of a screen, whether computer or TV; increasing outdoor play time; and reinstating gym classes in schools.
But she says turning a society away from sugar, salt and fat to whole grains and lots of exercise will take education and a change of social norms: Make it socially unacceptable to offer a dinner guest a fatty meal with high-calorie dessert. Instead of lunching with the ladies, meet them for a hike.
Kaufman knows that for many people, fresh vegetables are too expensive, and people who work long hours have little time to cook healthful meals. In some communities, finding a safe place for a daily walk or for kids to play is not easy.
"Lots of people feel that anyone who is overweight or has type 2 diabetes, it's their fault, that someone chooses to live this way," she says. "I've dealt with kids long enough and have seen what's available to them" in schools, their neighborhoods and at home.
Things are starting to change for the better, at least in some areas, Kaufman says. She cites programs to encourage walking and fitness, communities that open school gyms and running tracks to the public, and classes that teach people how to read a nutrition label and understand portion sizes.
"We're at a critical crossroads," she says. But "if we can continue to gather evidence that these interventions make a difference, we can start to push change. This is within our reach."