Halting the Childhood Obesity Epidemic: Could Diabetes Educators Help?

Friday, August 12, 2005
General Session

Speaker
James S Marks, MD, MPH

Reported by Joelle Escoffery, PhD

The obesity epidemic is “engine” behind the diabetes epidemic. Both conditions are increasing at alarming rates, especially among children and young adults. The costs of these conditions are enormous, in terms of both years lost and financial costs. In 2002, the cost of diabetes was estimated to be $132 billion, which in an enormous cost that does not yet reflect the full impact of the impending twin epidemics.

Although there is a genetic component associated with type 2 diabetes, the bulk of the increasing incidence is associated with environmental factors. Dietary environmental factors include increased frequency of dining out, increased portion size, increased reliance on fast food, and increased consumption of sugary sodas. There are environmental factors associated with decreased physical activity as well, including increased use of elevators and escalators, increased use of remote controls, more hours of screen time, activity-unfriendly neighborhood design, sedentary work environments, and the decreased availability of physical education in the school. The Centers for Disease Control and Prevention’s Guide to Community Preventive Services made a number of recommendations for physical activity promotion, including: point-of-decision prompts, community-wide campaigns, school-based physical education, community and social support interventions, individually-adapted behavior change, and enhanced access to physical activity.

A number of effective environmental and policy-based interventions have already been done. For example, walking has been shown to be increased when walking trails were made available. When school environments were altered to promote a healthy lifestyle, diet and exercise were improved, and the effects were sustained for 3 years. Legislation on safe routes to schools has provided funding to increase the safety of walking to school as a means of promoting physical activity. Finally, the VERB youth media campaign has been shown to increase leisure time physical activity by 22% among children who have been exposed to the campaign, compared with a physical activity decrease among children who have not.

Additional environmental or policy interventions include decreasing access to junk food in schools, increasing access to health food in schools, improving health education curriculum on nutrition, linking school food policies to the nutritional curricula, increasing physical education instruction, eliminating sales tax exemptions on unhealthy foods and using the money to fund health promotion programs, and the creation of workplace wellness programs. Although these strategies are often challenging, the have the potential to impact the growing incidence of diabetes and obesity.