March 2004 - Ranjita Misra really hates having to give parents something new to worry about, but the Texas A&M University health researcher says parents -- especially minority parents -- now need to be concerned about Type 2 or adult-onset diabetes.
"Childhood obesity and diabetes is a very new area. We did not have this problem a few years ago. Consequently, patients, health providers and family members are at a loss as to how to deal with the situation," Misra notes. Both diabetes and obesity among children has reached epidemic proportions as the fast-food restaurants are geared mostly to children and families. However, in recent days, the fast-food industry has made headlines by modifying their menus to be healthier.
One example of the problem she cites is from a colleague who reported the case of an obese five-year-old diagnosed with Type 2 diabetes, a disease that previously had a typical age of onset in the early 40s.
"This child cannot understand diabetes or its consequences," she adds.
The longer one has diabetes, the greater the physical damage is causes. Misra says diabetic patients are expected to be aware and educated about good nutrition, physical activity, knowledge of the disease and its complications and disease management mainly through regular blood tests and medications - all difficult things for a young child to comprehend or learn.
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Misra, who specializes in minority health disparities, has conducted extensive research on diabetes. In one of her recent publications in the "Journal of the National Black Nurses Association," on Type-II or adult-onset diabetes, she has shown that management of the disease is complex and difficult even for adults. The disease is the fifth-leading cause of death in America with a greater burden among the minority populations. For African-Americans and Latinos/Hispanics, the incidence of the disease is 1.5 and 1.6 times higher than non-Hispanic whites respectively.
How has this happened in our society and how do parents deal with it?
Misra says there are too many factors to name them all. They include parents with busy lifestyles who no longer have time to participate in outdoor activities with young children. Also busy parents have resorted to the option of relying too much on fast food as a source of regular meals for themselves and their families which in turn leads to many health problems. Added to these factors is the fact that children are not as safe playing outdoors as they once were, so they stay in more often and watch TV or play video games.
There also is the perception that eating healthy is more expensive. For some lower-income families, eating burgers and fries from the dollar menu during a busy day pleases the whole family, but that can lead to problems.
"For example, a large burger, fries and a soda can be as much as 1,500 to 1,800 calories in one meal when the daily calorie intake for an adult should be around 2,000," Misra points out.
She adds that a good portion of those fast-food calories come from sugar or fat because these are the ingredients that make food "tastier" and more enticing to the palate. So she believes the food industry must bear some responsibility for portion sizes and fat and sugar content and she is pleased to see that some fast food chains have taken the initiative by providing healthy alternatives.
Misra hopes that parents would first opt for healthier meals for themselves for their own sake but also as a way of setting an example to their children to demonstrate the virtues of eating healthy. After all children being children they cannot be expected to make "healthy choices" and it is incumbent upon the parents to make such choices for them. This can range from avoiding fast food altogether or making changes in their preferences such as opting for water or diet soda instead of the calorie ridden regular soda that children seem to love.
Also Misra further elaborates that healthy foods are not necessarily expensive if one were to make intelligent choices and adjustments in their dietary preferences. When it comes to children, she also states that good habits can be imbedded in kids by giving them smaller portions, by cutting them in to smaller pieces or different shapes so as to make it more enjoyable and fun.
Children who become diabetic also have to deal with peer pressure. They find diet choices confusing, and being different when it comes to picking out foods in the cafeteria can be an ordeal. "Young children are honest to the point of rudeness and being pointed out as different can be hurtful or damaging to their self-image," Misra adds.
For diabetic children, Misra says this can result in high-risk behaviors. She says they will eat foods they should avoid just to be part of the group and adds that young children and teens tend to think of themselves as invincible.
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Health care providers must also get more involved, Misra says. They must work harder to educate parents - especially minority parents - on healthier diets and advise them on how to encourage their children to be more active. Type 2 diabetes in children most often occurs during mid-puberty as changes in hormone levels during this period cause insulin resistance and decreased insulin action and parents need to be aware of this information. Low-income families may not be able to afford frequent trips to the doctor but, if they are aware of the problem, there is good information available to them through other sources such as the American Diabetes Association's Web site , school health programs, and local health departments.
Misra believes parents, schools, health providers and the food industry must begin working together to decrease the number of children who are obese and in danger of becoming diabetic.
"An overweight five-year-old with adult-onset diabetes is a warning we all should heed. Our children are in trouble and its time for our society to do something about it."
Source: Texas A&M
