Health Education: children and diet

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Directions in Childhood Obesity Prevention

In regard to childhood obesity prevention programs that I have spent the better of two weeks reviewing, I have chosen the CATCH one to promote to my community partners and community. To better help me wrap my mind around what I want to say, I will use you, my loyal blog readers, for a practice articulation. (I have found graduate school to be similar to emasculation – my ability to form cohesive thoughts and sentences is considerably weakened. As Sarah Palin might say WTF? Which, incidentally,  is the only time you will see THAT name in my blog) Back to childhood obesity… Though my review is far from complete or exhaustive, a concept or theme is developing. I see that the Coordinated Approach To Child Health, a revision of the Child and Adolescent Trial for Cardiovascular Health, is the program that is the most comprehensive, most studied and seemingly the most socio-ecological (it involves all areas of exposure – individual, school, home and community). CATCH has been involved in randomized controlled trials and evaluated for sustainability. After the initial transnational project, smaller studies on more diverse populations were completed. Though low-income schools with minority populations have been studied, the sole program that involved an adequate number of black children measured the changes in the school environment only. In other words, they did not look at knowledge, skill or behavior change on the individual level. In the larger trial, one district did have a 15% representation of black children, but during analyses it was noted that more black children were lost to follow up (left the schools) than the whites. According to our public health databases, black children have much higher rates of OW/OB than white children do, though all races have higher rates than expected/acceptable. It is this researcher’s assumption that individual subcultures are not the causal factor in our obesity epidemic. Instead, the overall culture or sociopolitical climate is obesogenic. Poverty, not race, promotes obesity as much as overconsumption. If we can deliver this comprehensive program in a majority black school and or majority low income school and allow these children the knowledge, skills and resources to eat well and exercise more– the positive outcomes will add to the research questions we ask and the policy decisions we make. This is not to say we do not to continue work with ALL children, but to make sure we do not leave out the group with the greatest risk. The studies already completed may have been nationally representative – meaning that they may have had the right proportion of race and gender to start the study, but they did not finish in parity. Even so, if most of our evidence for childhood obesity was on girls and not boys, wouldn’t that be a problem? And that is where I am headed with my research these days – though I also have a proposal in for a worksite wellness program that would be Internet based. I will let you know if that one gets funded :)

Directions in Childhood Obesity Prevention

In regard to childhood obesity prevention programs that I have spent the better of two weeks reviewing, I have chosen the CATCH one to promo...

6:45 PM

The Power of Brown

Those crazy scientists - always up to something. Back in 2009 I mentioned a story about the different types of fat that we have in our body. In <a href="http://yourhealtheducator.blogspot.com/2009/04/wellness-weekly_17.html">this wellness weekly</a>, I explained a little of what was being discovered and noted that the issue didn't get as much press as I'd expect. I did think that some company would continue to diligently work to somehow make the finding into an obesity treatment. Really, I said that and you can check by clicking the highlighted link. The body does have two types of fat cells. They are usually simply referred to as brown and white. They are very different. Without delving into too much biology, our body is made up of cells, tissues and organs. The cells have engines that require energy in order to divide, reproduce, secrete substances, etc. That energy for us is ATP which is created in the cell with oxygen. (Exercise can improve ATP production). The engines are actually mitochondria. Every cell has at least one, and as you might guess, the more mitochondria a cell has, the more energy it will need to keep those engines running or working. Researchers at Harvard and elsewhere, have found that the brown fat cells have an abundance of mitochondria where as white fat cells do not. Thus, the brown fat burns calories or uses energy and the white fat stores it. Most of us understand that too much energy in, in the form of food, can lead to an increase in white fat cells. What researchers what to do is figure out a way to get more brown fat cells. So far it seems that babies have the most brown fat but as babies become more able to do things, like move around to create energy and body heat, they have less and less brown fat. If they eat too much, well, then they have too much white fat. A specific protein in our body is the trigger for brown fat cell production. This protein can also stimulate the transformation of white fat cells TO brown fat cells. Holy Cows, now that would be something. Scientists are exploring ways to make the body create more of the protein (through gene expression), or find a chemical that will mimic the protein, or find a way to make the protein more powerful - all to get more brown fat cells in the body. In a WSJ article on this same topic, a Netherlands researcher cautioned that increasing energy burn in a person might also increase appetite. He was concerned that people who still eat too much. Another idea on the minds of researchers is exposing people to cold temperatures. Apparently, being in cold air can stimulate brown cell activity. Unfortunately, in the two or three experiments testing this hypothesis, it only worked with the lean people. Obese people have more insulation - as they have more white fat cells, and the job of the white cell is to conserve energy and insulate the person. White fat cells are very good at their job. My coworkers keep the air condition blowing cold most of the day at work so I have now started to accuse them of making me lose weight. Recently I wrote a piece about the need to stay dynamic in your weight control - weight maintenance. This was in regards to the research on middle age weight gain and needing to modify exercise AND calorie programs to make up for plateaus. It is clear from this Harvard research that pills do not change any of that. It is always going to be a matter of energy in and energy out. I am beginning to think, however, that some persons who have over consumed and over consumed the worst foods (processed) may really have irreversibly damaged some of the intricate chemical and hormonal workings of their metabolic systems. They may need more than diet and exercise, but that is a very small group of people and always always, pills and surgeries should be the last effort not the first.

The Power of Brown

Those crazy scientists - always up to something. Back in 2009 I mentioned a story about the different types of fat that we have in our body...

4:48 PM

gestational diabetes

I chose this topic today because a woman I care a great deal about has recently learned that she has gestational diabetes. So what is that and what does it mean? Diabetes is defined as having a blood sugar level over 130 if fasting and 180 if after a meal. When blood sugar levels run high after one becomes pregnant but not before, then it is gestational diabetes. (there are some instances of gestational diabetes however, that fall into the category of previous diabetes that was undiagnosed). There are not always symptoms, but increased thirst, light headedness and frequent urination are a few. A blood glucose test is usually performed during pregnancy. Gestational diabetes can cause problems and it is important to get blood sugar levels under control and to treat the condition with the utmost respect. Gestational Diabetes affects about 4% of pregnant women. It usually occurs and is diagnosed between the second and third trimester. Though only around 30% of women with gestational diabetes develop diabetes beyond pregnancy, there is a 60% chance that this will occur for each woman who has gestational diabetes. There is also increased risk of the infant becoming obese and also developing type 2 diabetes. What this really tells us is that the recommendations to maintain a healthy weight, to eat frequent, consistent, small meals and to exercise are universal and paramount. Women who are diagnosed with this condition, often because of screening during their sixth month, must control their blood sugars. When diagnosed, the mother should receive a referral to a certified diabetes educator who will assist in meal planning. How one eats can do a lot to prevent blood sugar spikes and thus less need for insulin to be secreted. Exercise can also reduce blood sugar, however, there may be a need for exogenous insulin and if so, special education on how to use the medicine is needed as well. No other diabetes medication is considered safe during pregnancy. Insulin and exercise are both known to lower blood sugar levels. Pregnant women should not start new vigorous exercise, but are usually able to continue with the same physical activity level they had before they become pregnant, unless of course they were sedentary. Walking is usually considered a safe activity. All women who are pregnant and especially those with these risks, should maintain regular prenatal care and get direction from their provider on what exercise is best and how often it should be done. With regard to controlling blood sugar through nutrition; frequent, small meals are suggested. Complex carbohydrates, whole grains, fruits and vegetables as well as lean proteins are recommended. It is also noted that saturated fat, fried and greasy foods should be avoided. Pregnant women are also encouraged to consume 20+ grams of fiber each day, and to drink plenty of water. As you can see, these suggestions are pretty much the same as those for the general population. These guidelines can reduce weight gain and prevent chronic disease. Women with gestational diabetes are also encouraged to monitor their weights. I cannot emphasize enough that this is not a disease to tackle on your own. The baby and the mother are at risk for problems - birth problems, growth problems and still birth. The risk is greatest if the diabetes is not controlled. This is different than being diagnosed with DM2 and twenty years later having a heart attack from it - the adverse outcome can happen within months if the condition is not taken seriously. Risk factors and etiology: There are some risk factors, but please note, many cases of gestational diabetes are in women who did not have the named risk factors. If you are curious, they include - being overweight prior to pregnancy, being over age 25, having had gestational diabetes during a previous pregnancy, having a family history of diabetes, and being a person of color. The disease develops (etiology) during the course of a normal pregnancy phenomena. When pregnant, the placenta itself makes hormones. The hormones have many effects but one is to reduce the impact of the mothers insulin on her blood sugar level. The idea is to increase nutrient flow from the mom to the baby and in so doing the mom might be at risk for low blood sugar, so the body is trying to prevent that outcome by interfering with natural insulin response. However, sometimes that back fires and the mothers blood sugar is too high. Usually the mother will begin to produce extra insulin (from the pancreas) to account for this change, but in gestational diabetes this extra insulin does not move the blood sugar out of the blood stream. The infant's pancreas is also working so that when the infant has too much blood glucose, it will release insulin. The glucose passes through to the baby but the mom's insulin doesn't. Glucose or blood sugar that cannot be used is stored as fat. The baby is at risk for a condition in which it has too much fat (macrosomia) at birth and it will continue to be at risk for obesity and diabetes after birth. All this being said, controlling the blood sugar of the mother, through smart eating and exercise can prevent these adverse outcomes. A woman with this condition should take advantage of any and all resources made available to them by their OBGYN. To control the blood sugar, testing is required. Certified Diabetes Educators, both nurses and dietitians can educate on how to test blood sugar and use insulin if needed. Blood testing cannot be avoided. The baby may also undergo fetal monitoring, ultrasound and other tests as the pregnancy progresses. At birth the baby will undergo some testing to make sure his or her blood sugars are normal. Again, the baby will be at risk for obesity which is a big factor in diabetes - parents should provide the child with the same healthful diet the mother was encouraged to consume. After birth, the mother will also be tested for some time to see if her blood sugar and insulin response returns to normal. It should because the placenta is no longer there to cause hormone challenges, but again about one third of women will develop diabetes, or may have had undiagnosed diabetes prior to pregnancy. If you have this condition you should read more, as the links below were my resources. Start here: <a href="http://www.cdc.gov/ncbddd/bd/diabetespregnancyfaqs.htm#willmybaby">http://www.cdc.gov/ncbddd/bd/diabetespregnancyfaqs.htm#willmybaby</a> and here: <a href="http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html">http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html</a> and here: <a href="http://www.webmd.com/baby/tc/gestational-diabetes-topic-overview">http://www.webmd.com/baby/tc/gestational-diabetes-topic-overview</a><a href="http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html"></a>

gestational diabetes

I chose this topic today because a woman I care a great deal about has recently learned that she has gestational diabetes . So what is that...

4:48 PM

The Home Front

I had set aside an article regarding fighting childhood obesity on the front lines, meaning the home. It was an okay story, but it didn't really move me, so there isn't much to quote or even reference. That said, it did inspire a few thoughts. Most importantly, if we want our children to be healthy, we must be mindful of their nutrition. An overweight child faces some challenges, and there are enough of those without adding extra. Not only does the weight itself pose problems, but the typical overnutrition that supports weight gain, also compromises performance, learning and social acceptance. In order to better serve our children, we should better serve ourselves. It is as important to remove junk as it is to provide healthy food. If it is not there they will not eat it. That goes for both. If you want your children to be healthy and to care about their bodies, then you must do the same. It is a mandate for the entire household. Nor does it stop with food. Do you want active children? Be active. We cannot afford to miss the boat on this. Overweight children end up with chronic diseases. Sure we have medications for that, but starting a 13 year old on a blood pressure medication is, oh I don't know, INSANE...... it is not the answer. To reduce the disease impact, a child might lose weight, but to prevent the disease altogether, the parent might make obesity much less of a possibility. I have to say, it reminds me of a phrase I often voice in the tobacco wars, which is, "It is far easier to never smoke than it is to quit." And so, it IS easier to never get fat then it is to lose weight. Perhaps it sounds offensive to say "fat" but it is what it is and it is not an aesthetic thing. Fatness, or obesity is a disease construct. Go through your kitchen this weekend, or next. Make it a healthy one. Everything in moderation and more so some things than others, but don't expect your children to take care of their bodies if you are not willing to do the same. Make it a Family Affair - to Fair Well.

The Home Front

I had set aside an article regarding fighting childhood obesity on the front lines, meaning the home. It was an okay story, but it didn...

5:42 PM

Health Education

Directions in Childhood Obesity Prevention

The Power of Brown

gestational diabetes

The Home Front

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