Original Publish Date: February 5, 2015
Physicians, schools and community organizations across Central California now have access to a resource that helps identify diabetes risk factors in children.
Valley Children’s Healthcare launched a comprehensive diabetes education, prevention and treatment program that draws on the expertise of seven pediatric endocrinologists, two nurse practitioners, four diabetes educators and a registered dietitian who work in the pediatric endocrinology practice at Valley Children’s Hospital.
“Fifteen years ago we didn’t see type 2 diabetes in kids,” said Dr. Renee Kinman, a pediatric endocrinologist at Valley Children's. “But today it’s more common.”
Type 2 diabetes significantly reduces life expectancy and increases the chance of heart attack and stroke, and, sadly, this generation of children is expected to experience a troubling number of new cases. The Centers for Disease Control and Prevention estimate that one in three children born in the U.S. in the year 2000 will develop type 2 diabetes at some point.
The need for education and prevention has grown, especially in certain neighborhoods common to Central California, where unemployment rates exceed the national average. Studies have shown that obesity rates are higher among low-income families. However, food costs are not necessarily the reason.
“I show families price comparisons of chips and a soda with an apple and water bottle,” said Linda Erickson, a registered dietitian at Valley Children's. “It’s not always cheaper to eat junk food.”
Metro areas and rural communities in Central California often do not have nearby markets selling healthy food. But numerous convenience stores and fast food restaurants dot the landscape, serving up sugary drinks, starchy foods, high-fat snacks, and little or no produce. Eating well in a “food desert” takes motivation and a shopping plan, and the program at Valley Children’s help families with both.
Studies conclude the increase in type 2 diabetes among children is due to obesity, physical inactivity and prenatal exposure to diabetes in the mother.
“When I see a darkening around the neck, I tell my patients they’re headed for diabetes if they don’t already have it,” said Dr. Kinman, who uses compelling images to show patients what obesity looks like on the inside. “My picture of a healthy liver next to one with fatty liver disease always gets a reaction,” she said. “They don’t want that to happen to them.”
The comprehensive program at Valley Children’s helps families understand the serious consequences resulting from type 2 diabetes. They are taught the vital role insulin plays in converting glucose into energy, and learn how the insulin resistance and insulin deficiency characteristic of type 2 diabetes “locks” glucose in the bloodstream, where it can reach dangerously high levels.
“Gentle, factual education can motivate,” said Erickson. “Our job as a children’s hospital is to deliver that information. Families need to know what could happen if they continue making wrong choices.”
Families also learn that type 2 diabetes can be reversible. “But only if you make changes in time,” said Dr. Kinman. With insulin resistance, the pancreas initially increases insulin production, and later decreases production. As long as the pancreas continues producing insulin, weight loss and physical activity can “unlock” cells and lower blood glucose levels.
The pediatric endocrinology team at Valley Children’s Hospital specializes in treating children, and they understand that helping kids make lifestyle changes presents a unique set of challenges.
“We’ve redefined the word ‘exercise,’” said Bob Orcutt, a physical therapist at Valley Children’s Hospital. “We use the word ‘activity.’ Perceived exertion is the biggest stumbling block for kids to get active, but an activity doesn’t have to be huffing and puffing.”
“I ask them, ‘What do you like to play?’” said Dr. Kinman. “The best exercise is exercise that’s fun. If it’s not fun, what’s the chance your child will do it?”
“The thought of exercise can overwhelm and embarrass children,” said Orcutt. “Insecurities and fears about participating in sports or other conventional forms of exercise may shut them down. We never say the need for exercise is all about their weight. We say, ‘You have muscles that could be stronger.’ We demystify the perception of going out there and torturing yourself. Just get out there and do something and the more you do it, the easier it’s going to get.”
Too many children living in the region served by Valley Children’s come home to neighborhoods where gang activity and other crime rule out possibilities of playing outside or riding bikes. Valley Children’s serves as a resource to locate supervised activities sponsored by groups like Boys & Girls Clubs of America, which work well in these situations. Parents involved in the program learn to overcome obstacles and encourage activity. Jumping rope, using exercise videos and even playing Wii or Xbox Kinect help children get moving while staying inside.
“Parents can motivate their children by keeping their words positive,” said Erickson. “Simply ask, ‘Do you want to feel better?’”
“If you’re not eating good food, you don’t feel like exercising,” said Orcutt. “But when you start eating right you have more energy.”
Making healthy food choices often depends on parents, which is why Valley Children’s educates the entire family on diabetes prevention measures. A pantry full of chips and other high-fat snacks serves as a magnet to children who reach for them between meals. Modified shopping habits can greatly reduce fat intake and increase a child’s consumption of fruits and vegetables.
Snack time can be a great time for parents to introduce fruits and vegetables. Families learn to make snacking fun and healthy by whipping up nonfat, sugar-free yogurt with a dash of cinnamon or vanilla as a dipping sauce and serving it with apple slices. Or adding garlic and herbs to the yogurt instead and serving with carrots, broccoli or cauliflower. Healthy recipe ideas also include bugs on a stick, which have satisfied generations of young snackers. Kids enjoy spreading peanut butter on a celery stalk and topping with ants (raisins), ladybugs (cranberries) and beetles (dried cherries).
Parents learn that if their children are hungry at mealtime, they’re more likely to eat the healthier food placed before them. “If they don’t like the food you’ve prepared and refuse to eat it, don’t let them eat something else right away,” said Erickson. “Tell them it’s important for the family to sit together.” Erikson also recommends parents teach their kids to cook. “Studies have shown that children are 80 percent more likely to enjoy their food if they’re involved with the cooking,” she said.
When children eat less and move more they greatly reduce the risk of diabetes. Dr. Kinman helps her patients set achievable, short-term goals.
“I ask, ‘What’s your goal for the next week?’ and let them tell me,” she said. “We take little steps toward that goal.” Trying to make all the changes at once can overwhelm a child.
The diabetes prevention and treatment program offered by Valley Children’s Healthcare teaches families how and why to make the right choices for a healthier lifestyle. These efforts will help reduce the rate of childhood obesity and improve the wellbeing of Central California’s children.
Shawna Bryant is a communications specialist for Valley Children’s Healthcare, a network of pediatric care providers and medical facilities serving a 45,000 square-mile region in Central California. A nonprofit, pediatric regional medical center on a 50-acre campus near Fresno, Valley Children’s Hospital is one of the largest hospitals of its type in the nation. The 356-bed facility has a medical staff of more than 550 physicians, offers more than 40 pediatric specialties, and consistently ranks at the top of its peer group for quality patient outcomes and patient satisfaction. Valley Children’s has received repeated designations for nursing care excellence from the Magnet Recognition Program®.