Prevention of Prediabetes and Type 2 Diabetes with Weight Management in Children and Adults

Hope S. Warshaw, MMSc, RD, BC-ADM, CDE
Hope Warshaw Associates, LLC
Alexandria, VA

It is always exciting and rewarding to be involved in Diabetes Care and Education (DCE) projects! They provide opportunities to learn and grow. Coordinating this issue of OTCE has been no exception.

The DCE Leaders simply provided me the theme of “weight loss and diabetes.” Hmmm, quite broad, I remember reflecting. To narrow the scope and create a valuable issue of OTCE, I assembled a dynamic theme team: Susan Burke March, MS, RD, CDE; Joanne Gallivan, MS, RD; Joyce Green Pastors, MS, RD, CDE; and Helen Thompson, MS, RD, CDE. I thank them for their passion, varied expertise and professional commitment. Our intent, even in light of the dismal statistics about obesity, prediabetes and type 2 diabetes (T2DM), was to demonstrate that there are reasons to be hopeful about our collective ability to stem the tide of these epidemics through effective lifestyle interventions.

The Grim Stats

Nearly all the authors wanted to begin with the following disheartening statistics. To preserve precious space for our author’s positive messages, the pertinent statistics are as follows:

Overweight and obesity in adults in the U.S.: According to the latest (2003-04) data from the National Health and Nutrition Examination Survey, obesity rates have increased in the past 25 years and approximately one-third of adults are overweight (i.e., having a body mass index [BMI] >25 and <29.9) and another one-third are obese (BMI >30). This figure is more than 140 million American adults (1).

Overweight and obesity in children and adolescents in the U.S.: Obesity has become the most prevalent chronic disorder in children (2). Since 1980, prevalence of overweight children has nearly tripled among 2 to 5 year olds, and more than tripled among youth ages 6 to 11 years and adolescents ages 12- to 19 years. About 17% of American children ages 2- to 19 years are overweight and 5 million are obese (BMI=95th percentile) (3). Particularly distressing is that overweight children are more likely to become overweight or obese adults.

Overweight and obesity in minority populations: Both children and adults who are Hispanic Americans, African Americans and Native Americans have a greater prevalence of overweight and obesity than non-Hispanic whites (1,3).

Prediabetes in the U.S.: Approximately 57 million Americans have prediabetes (4). It is estimated that up to 70% of these individuals will develop T2DM over time (5). Even more Americans have metabolic syndrome or risk factors for this syndrome, which puts them at risk for prediabetes and T2DM.

Diabetes in the United States: Nearly 23.6 million people have diabetes, representing 7.8% of the population. Nearly 5.7 million, have diabetes but have not yet been diagnosed (4). Table 1 provides the criteria and diagnosis of prediabetes and diabetes (6).

Type 2 diabetes in youth: In 1992, most U.S. pediatric diabetes centers reported that 2% to 4% of their clients with diabetes had T2DM. By 1999, this figure ranged between 8% and 45% (2,7) and occurred mainly among ethnic youth. Most children who develop T2DM have a family member with T2DM.

Future prevalence of diabetes: Data suggest that the lifetime risk of HOPE S. WARSHAW, MMSc, RD, BC-ADM, CDE HOPE WARSHAW ASSOCIATES, LLC ALEXANDRIA, VA. diabetes for Americans born in 2000 is one in three for males and two in five for females (8) and is even higher among ethnic populations. By 2050, the prevalence is projected to be 39 million (9).

Direct and indirect cost of diabetes in U.S.: Estimates of the cost of diabetes in 2007 are $174 billion, with direct costs of $116 billion and indirect costs of $58 billion (10).

The Articles Ahead

From the vantage point of preventing and managing weight gain, metabolic syndrome and prediabetes, and reining in the long-term economic burden of these and related chronic diseases, primary prevention of overweight and obesity are priorities in both the public and private sectors (11). As explored in this issue of OTCE, questions and challenges remain about how to help people, as individuals and members of communities stay motivated to lead healthier lifestyles that include weight management.

A big thanks is due to the many passionate colleagues who wrote articles. The content in this issue of OTCE is divided into three sections. We begin with children and adolescents. Cali and her colleagues Savoye and Caprio, from Yale’s Department of Pediatrics, review the pathophysiology of insulin resistance in youth. Pastors and Yager provide a bird’s-eye view of how they built a childhood obesity community task force. Next there is an interview with Brenda Z. Greene, the Director of Health for the National Association of School Boards. Articles by Donato, Lipton and Kaufman, and Savoye profile successful healthy lifestyle programs for children. Kaufman updates us on the HEALTHY Trial. Segueing from children to adults, Fletcher compares and contrasts how adolescents and adults maintain weight loss.

Bissett has written an in-depth review of the intervention tools used in prediabetes prevention trials. Marrero and Ackermann review the findings from implementing the Diabetes Prevention Program model in YMCAs. Continuing on the prevention theme, Ernst, from the Centers for Disease Control and Prevention’s Division of Diabetes Translation, describes the five-state Diabetes Prevention Program Initiative. Thompson and Krygowski present a logical approach to a concept that receives too little attention— prevention of weight gain. Burke March explores online weight management programs and Thompson helps us identify sources and resources for funding healthy lifestyle and disease prevention initiatives.

This issue of OTCE concludes by increasing your awareness of initiatives from our association. Biesemeier and Gee review Adult Weight Management and Pediatric Overweight and Obesity Guidelines in the ADA Evidence Analysis Library and contents of related toolkits. Finn, Chair of the American Dietetic Association Foundation, discusses the foundation’s initiatives in this area.

Big thanks go to two more people: Cynthia Goody, PhD, RD, OTCE Editor, and Alison Evert, MS, RD, CDE, Communications Chair. Their spirit of volunteerism and professionalism are second to none. I appreciate their assistance from beginning to end.

After reading this issue of OTCE, I hope you will agree that the time for wringing our hands about the epidemics of obesity, prediabetes and T2DM is over and the time for action by each one of us is NOW! For additional background, take time to review the April 2008 supplement to the Journal of the American Dietetic Association developed with DCE (12). As you work in your communities, look nationally for effective programs and resources. Then act locally. There is no need, or time, to reinvent the wheel. As this issue of OTCE repeatedly emphasizes, it will take both a bottom-up (parents, school organizations, communities and more) and top-down (federal governments, business and/or health-care coalitions, and more) approach to create healthier environments that promote healthier eating and more physical activity. Let us all keep the ball of change spinning in a wide array of positive directions.

References

1. National Center for Health Statistics. Prevalence of overweight and obesity among adults, 2003-2004. Hyattsville, Md.: National Center for Health Statistics; 2004. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_adult_03.htm. Accessed April 2, 2008.

2. Ogden CL, Carroll M, Curtin L, et al. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295:1549–1555.

3. National Center for Health Statistics. Prevalence of overweight and obesity among children and adolescents, 2003-2004. Hyattsville, Md.: National Center for Health Statistics; 2004. Available at: http://www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_child_03.htm. Accessed April 2, 2008.

4. Centers for Disease Control and Prevention. National Diabetes Fact Sheet. Atlanta, Ga.: Centers for Disease Control and Prevention; 2007. Available at: http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf. Accessed June 25, 2008.

5. Nathan EM, Davidson MB, DeFronzo RA, et al. Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care. 2007;30:743–759.

6. American Diabetes Association. Standards of Medical Care in Diabetes—2008. Diabetes Care. 2008;29(supp 1):S12–S54.

7. Alberti G, Zimmet P, Shaw J, et al. Type 2 diabetes in the young: the evolving epidemic. Diabetes Care. 2004;27: 1798–1811.

8. Narayan KM, Boyle JP, Thompson TJ, et al. Lifetime risk for diabetes mellitus in the United States. JAMA. 2003;290: 1884–1890.

9. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–1053.

10. American Diabetes Association. Economic costs of diabetes in the U.S. in 2007. Diabetes Care. 2008;31:596–615.

11. Fradkin J, Rodgers GP. The economic imperative to conquer diabetes. Diabetes Care. 2008; 31:624–626.

12. Wylie-Rosett J, ed. Emerging trends in diabetes prevention and control: applications to practice. J Am Diet Assoc. 2008;108(supp):S3–72.