How do you prevent a deadly disease that is projected to afflict one third of all Americans born today and is caused largely by hard-to-change habits such as too much soda and snacks and too little physical activity?
You could combine the broccoli and cauliflower in the school cafeteria for more colorful eye appeal. Put out 30 basketballs in gym class instead of two. Teach the wonders of water for 15 weeks straight (and remove everything else from vending machines).
Those changes – along with hundreds of others, large and small – signficantly reduced several major risk factors for type 2 diabetes, researchers concluded last week after studying the most comprehensive attempt yet to attack the epidemic through the schools.
Lifestyle prescriptions – you should eat a balanced diet – are notoriously difficult to stick with. But these limits were impossible to avoid.
“Instead of selling candy for a fund-raiser, they were selling carnations. And those are the sort of things that made it holistic across the environment,” said Wayne Grasela, senior vice president for food services in the Philadelphia School District, where six middle schools took part in the three-year national program.
The plan was to intervene early, before diabetes develops – and at a young enough age to learn new habits that could prevent or reduce obesity, a major risk factor for the disease. Numerous physicians helped craft the program, but all the action took place in the schools.
“They are already there. They already take physical education and they already eat lunch in the school,” explained Barbara Linder, who oversaw the study for the National Institutes of Health.
So researchers set about changing the school.
In gym, for example, “instead of doing layups, with most kids standing in line, we had things set up so balls were being passed back and forth while they waited,” said Gary D. Foster, director of Temple University’s Center for Obesity Research and Education, who chaired the national study.
Dumbbells, jump ropes, and medicine balls were distributed to groups, with rotations every 45 to 90 seconds to keep everyone moving. Pop music was played so that gyms were seen as “fun places to be with cool things to do,” Foster said.
In the cafeteria, the standard pizza was replaced with the same manufacturer’s whole-grain, lower-fat version. That shaved nearly 100 calories per slice and the kids didn’t notice, said Amy Virus, a registered dietician at Temple who coordinated the study’s nutrition component.
Nothing but water – not even 100 percent fruit juice – was stocked in vending machines. “Did they miss the juice? Sure, in the beginning,” Virus said, “but they got used to it. And they were buying the water.”
Supporting the effort were posters in classrooms (kids dancing, kids eating fruit), decals sent home over Christmas (TAKE THE FAMILY TV TURNOFF CHALLENGE!) and postcards in summer (“Be active for 60 minutes every day.”), even a healthy version of Jeopardy!, with 25 cards in English and Spanish.
An estimated 24 million Americans have diabetes, a chief cause of kidney failure, limb amputations, blindness, heart disease, and stroke. Although type 1 diabetes is caused by an auto-immune disorder, type 2 – more than 90 percent of the cases – is often linked to lifestyle factors that lead to weight gain and a gradual loss of the ability to control blood sugar.
Once rare before adulthood, type 2 diabetes has been rising steadily in children. Blacks and Hispanics are at particularly high risk; the government now projects that half of all babies born in those minority groups will develop diabetes later in life.
The new program was designed by researchers at seven major universities and targeted schools that enrolled high percentages of poor and minority students.
They began the interventions in 21 schools – three in each city – in the fall of 2006, when the students were in sixth grade; another 21 schools were designated as controls. A total of 4,603 students completed the study in June 2009, at the end of eighth grade.
Analysis showed that there were significantly greater reductions in several diabetes risk factors – body-mass index scores, average insulin levels, and the percentage of students with the largest waists – at the intervention schools vs. the controls.
All those differences were more pronounced among the 50 percent of students who were overweight or obese to begin with. Within that group, the interventions were associated with 21 percent lower odds of being obese at the end of eighth grade, the researchers reported.
The results were published last week online in the New England Journal of Medicine.
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