A Diabetes ‘Epidemic' Type 2 cases involving children are skyrocketing
Five years ago, VCU Medical Center decided to address the increase in the number of adolescents at high risk for type 2 diabetes by launching T.E.E.N.S., an ongoing research program to identify the barriers that keep overweight teens from healthier lifestyles. T.E.E.N.S., which stands for Teaching, Encouragement, Exercise, Nutrition and Support, takes a look at obesity, which local medical professionals say is the No. 1 trigger for type 2 diabetes, a disease that currently affects 23.6 million people in the United States.
"The program is a multidisciplinary, family-based intervention for overweight children and adolescents ages 11 to 18 years," says Dr. Edmond Wickham, assistant professor of medicine and pediatrics in the division of endocrinology and metabolism at the VCU Medical Center. "One of the things we are hoping to figure out is to identify barriers [to] why some children in some families have success and others not."
T.E.E.N.S. studies adolescents whose weight is above the 85th percentile for their age, height and gender. Free to participants, the program means a two-year commitment and includes four major components, with multiple sessions per week — standardized nutrition education, supervised physical activity, behavioral support, and parent education and intervention.
Standardized nutrition education involves a series of 24 half-hour lessons that teens and their parents work through in a bi-weekly, private session with a registered dietitian. Topics include healthy snacking, not skipping breakfast and high-risk behaviors such as drinking soda and other sugary beverages. "We do not propose caloric goals but instead target high-risk behaviors," Wickham says. "Our goal is to encourage and promote lifelong healthy eating and physical-activity habits."
Participants also attend hour-long sessions of supervised exercise at the VCU Medical Center gym — three times per week for the first 12 weeks and then twice per week after that — which feature 30 minutes of cardio followed by 30 minutes of resistance or weight training conducted by the VCU Department of Health and Human Performance.
Behavioral-support conversations led by psychologists are held in bi-weekly groups — separate sessions for parents and boy and girl participants — in the hopes that peer advice will equip the participants and their families to apply the principles of healthy living in a practical way. For parents, these intervention groups are specifically intended to help them "assess their own health behaviors and to equip them with tools to positively discuss weight and health issues with their adolescents," Wickham says.
One of the most striking findings from the 400 adolescents who have participated so far (more than 50 are currently enrolled) is the necessity of healthy family role models.
"We have discovered that one of the strongest predictors of if the adolescent will lose weight is their parents' participation in the program," Wickham says. "Their parents and family members play an important role in helping an overweight adolescent be successful."
Another research program at VCU, Nourish, which was launched in 2006 to work with parents to treat obese children ages 6 to 11, has found similar results. Parents are the most important predictor of their children's success in establishing and maintaining a healthy lifestyle, says Dr. Suzanne Mazzeo, associate professor of psychology and pediatrics at VCU Medical Center.
"It's not what you put on the table. It is not what you feed them — it's what you eat," Mazzeo says. "The most important predictor of how many fruits and vegetables your child will eat is how many you eat. And the same goes for exercise. It's more of what you do and not what you say."
NOURISH stands for Nourishing Our Understanding of Role-modeling to Improve and Support Health. To help parents do this, the focus of the NOURISH program, which has had about 150 participants to date, is training parents so they can teach their children. One of the keys is changing an entire family's lifestyle, not just the habits of one child, Mazzeo says.
"We saw clinically that parents are really struggling with not wanting to treat one child differently, and children were struggling with feeling that they were targeted in their family. We call it the identified patient," she says. To combat this, NOURISH provides six weeks of group sessions led by master's-level VCU students overseen by Mazzeo. The topics range from emotional eating and portion size to feeding your family healthy meals on a budget and the effects of the media on image.
For both programs, results have been positive. NOURISH has produced a decrease in the BMI of both the kids and parents in the program, as opposed to a group randomly selected to participate in a one-time session, whose BMI increased during the study. The T.E.E.N.S. results have also included a decrease in BMI, with weight loss depending on participation.
Adolescents interested in the T.E.E.N.S. program may call Janet Delorme, program coordinator, at 827-0661, or visit vcu.edu/teens. For more information on the NOURISH program, call 827-9211.