Intervention Lowered Obesity Rate in Youth at High Diabetes Risk, HEALTHY Study Finds
An intervention in middle schools lowered the obesity rate in students at highest risk for type 2 diabetes, those who started out overweight or obese in sixth grade, an NIH-funded study has found. However, schools that implemented the program did not differ from comparison schools in the study's primary outcome the prevalence of overweight and obesity combined which had declined 4 percent in both groups of schools by the end of the three-year study.
The goal of the HEALTHY Study was to determine whether changes in school food services; longer, more intense periods of physical education; and classroom activities to promote behavior change would lower risk factors for type 2 diabetes. Conducted from the beginning of the sixth grade to the end of the eighth, the study involved 4,600 students attending 42 middle schools in seven areas of the country. Schools were randomly assigned to implement the program or serve as a comparison school.
Researchers were surprised to find that the number of overweight and obese students had declined in comparison schools as well as program schools. "The decline in the number of overweight and obese children in comparison schools was a welcome but unexpected finding," said study chair and lead author Gary D. Foster, Ph.D., of Temple University, Philadelphia. "Future analyses will try to clarify the reasons for the improvement in these schools. For example, we'll look at the comparison schools to see if they made healthy changes to the school environment because of increased awareness about the problem of childhood obesity."
Students in program schools who were overweight or obese in the sixth grade had 21 percent lower odds of being obese by the end of the eighth grade compared with students in control schools. Nationally, about one-third of children are overweight or obese, but in schools participating in the study, half of students were overweight or obese in sixth grade.
At the end of the study, 35 percent of children in both intervention and comparison schools with a BMI in the 95th percentile or greater had high insulin readings, compared with 2 percent of students whose BMI was less than the 85th percentile.
The program also lowered average levels of fasting insulin and the number of students with a waist at or over the 90th percentile in students in intervention schools compared with comparison schools. A high blood level of insulin after an overnight fast and a large waist increase the risk of developing type 2 diabetes, independent of body weight. However, the two groups did not differ in mean glucose levels or the percentage of students with elevated fasting glucose. A higher-than-normal level of fasting blood sugar indicates a greater risk of developing type 2 diabetes.
Because type 2 diabetes disproportionately affects minorities and low-income people, the study was conducted in schools with a high enrollment of minority children (54 percent Hispanic and 18 percent African-American) and youth from low-income families. About 75 percent of students were eligible for free or reduced-price meals.
At the beginning of sixth grade, many students had signs of high diabetes risk. Nearly half were overweight or obese, 16 percent had elevated fasting blood glucose levels, and nearly 7 percent had elevated fasting insulin levels. At the end of the eighth grade, students were tested for diabetes risk factors, including fasting blood levels of glucose, insulin, and lipids as well as height, weight, blood pressure, fitness level, and waist circumference.
About 24 million people in the United States have diabetes. It is the main cause of kidney failure, limb amputations, new onset blindness in adults and a major cause of heart disease and stroke. The longer a person has diabetes, the greater the chances of developing serious damage to the eyes, nerves, heart, kidneys, and blood vessels.
Type 2 diabetes, which accounts for up to 95 percent of all diabetes cases, becomes more common with increasing age. The disease is strongly associated with obesity, inactivity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, and racial or ethnic background. The prevalence of diagnosed diabetes has more than doubled in the last 30 years, due in large part to the upsurge in obesity. For more information about diabetes, visit http://diabetes.niddk.nih.gov/index.htm.
More than two-thirds of U.S. adults age 20 and older are overweight or obese. Among youth 2 to 19 years old, about one-third have a BMI at or above the 85th percentile for their age. Once seen only in adults, type 2 diabetes has been rising steadily in youth. The SEARCH for Diabetes in Youth Study, funded by the Centers for Disease Control and Prevention and the NIH, is examining diabetes rates in youth.
The NIH sponsors We Can! Ways to Enhance Children's Activity and Nutrition- a program to prevent childhood obesity that encourages parents and children to adopt healthy eating habits, increase physical activity, and reduce leisure "screen time" to prevent childhood obesity. We Can! materials, including fact sheets, brochures and curricula for adults and children, are available at http://wecan.nhlbi.nih.gov or by calling toll-free 1-866-35-WECAN.