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- NEW YORK (Reuters
Health) - Imagine that you are an overweight child who is diagnosed with
a disease that will guarantee a premature death in middle age. Over the
years, you might develop heart disease or kidney failure. Arterial disease
may cost you your sight, or a limb.
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- Now, suppose that you could avoid these problems by replacing
your favorite high-fat, sugary snacks with foods like apples, bananas and
low-fat yogurt, and exercising regularly to maintain a normal weight.
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- This is a very real scenario for the increasing number
of American children diagnosed with type 2 diabetes. The rise in type 2
diabetes cases in young people has led experts to label the disease an
emerging epidemic.
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- Until recently, the disorder was known as adult-onset
diabetes because it occurred mostly in men and women over age 50. Type
1 diabetes, which requires insulin treatment, was thought to be the only
form of the disease that occurred in children and adolescents. But the
past 20 years has seen a steady rise in the number of children and adolescents
who are diagnosed with type 2 diabetes, interviews with medical experts
reveal.
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- ``If you go back 20 years, about 2% of all cases of new
onset diabetes (type 2) were in people between 9 and 19 years old. Now,
it's about 30% to 50%,'' noted Dr. Gerald Bernstein, a past president of
the American Diabetes Association (ADA) and an endocrinologist with Beth
Israel Medical Center in New York City.
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- Health experts blame the trend on burgeoning rates of
obesity among children and adolescents during the past three decades.
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- The trend has profound implications for the long-term
health of America as many children go undiagnosed. While more and more
young people are showing up in their doctor's offices with symptoms, it
still does not occur to many physicians to run a diagnostic blood test,
since the disease is still considered rare among children. But because
symptoms can only be controlled after a diagnosis is made, many children
are at risk for serious medical complications.
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- Among adults, diabetes is the leading cause of blindness,
kidney failure, limb loss, a major cause of heart disease and the sixth
leading cause of death, Bernstein said. ``All of this is preventable if
you control blood sugar, but in order to do that you have to know that
the disease is present.''
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- For instance, a boy who develops type 2 diabetes in his
teens and is left untreated will have problems with his eyes, kidneys,
lower extremities and heart by the time he reaches his early 30s.
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- Indeed, the emerging epidemic of type 2 diabetes among
children reflects a trend in the population at large. Last month, the Centers
for Disease Control and Prevention (CDC) issued a report chronicling a
70% rise in the number of 30- to 39-year-old adults with the disorder between
1990-1998. Over the same period, rates of the disease rose by 40% among
those aged 40 to 49, and by 31% among those aged 50 to 59, according to
the report.
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- Problems have been simmering for decades as Americans
have continued to put on weight. Researchers estimate that nearly half
of all adults are overweight and nearly one-fifth are obese, or at least
30 pounds overweight.
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- Likewise, about 11% of the nation's 6- to 17-year-olds
were overweight in 1998, compared with about 5% in 1970. As young people
continue to gobble up sweets and fatty foods, researchers expect to see
type 2 diabetes more frequently in children.
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- Other risk factors besides obesity include race, ethnicity
and low socioeconomic status. Blacks, Hispanics and Native Americans are
at greater risk than whites, partially due to greater consumption of processed
foods. Research has also shown that these populations may be genetically
predisposed to obesity due to slower metabolisms, a trait that has evolved
over thousands of years.
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- While there is no cure for diabetes, diet and exercise
are often enough to control the disease and prevent complications.
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- ``Diet and exercise are keystones to treatment,'' Dr.
Michael M. Engelgau, a medical epidemiologist with the CDC's division of
diabetes, said. ``In some cases, it may be all that's needed.''
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- Ostensibly, diet and exercise are crucial to weight loss.
But studies have also shown that exercise can help to stabilize blood glucose,
the primary goal of diabetes treatment, and make the cells more responsive
to insulin. Obesity and inactivity appear to increase the cells' resistance
to insulin.
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- But while a thrifty metabolism is useful when there is
little food to go around--as in prehistoric times--it is a recipe for chronic
disease in modern-day America, where there is enough food to provide each
person with about 3,800 calories a day, said Dr. Marion Nestle, director
of the department of Nutrition and Food Studies at New York University.
Most adults, she said, need between 2,000 to 2,500 calories a day to survive.
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- ``The surplus makes the food system competitive and food
companies must sell food by getting people to eat more...or seek new audiences
for their products--i.e., children,'' Nestle said. ``That's why marketing
to children has become so fierce. The pressure to eat more and often fosters
obesity; obesity fosters diabetes.''
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- Health experts suggest the only way to reverse the trend
and avoid the medical complications and healthcare costs is to put America's
kids on a diet and encourage physical activity. According to Dr. Arlan
Rosenbloom, a pediatric endocrinologist in Gainesville, Florida, diet and
exercise could reduce the rate of type 2 diabetes in children by 60% to
80%.
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- That prescription could be difficult to fill in a country
that does not seem to value physical education in the schools. According
to a recent report, only 25% of US public schools require students to take
physical education class, down from 42% in 1991. In addition, many have
canceled after-school activities at a time when they are needed the most.
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- ``Physical education needs to be mandatory and fun,''
Rosenbloom said. ``We need after-school programs for non-athletes, a much
greater investment in group physical activity, and we need to encourage
families. That's where churches and community centers come in.''
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- These initiatives, he said, are investments in the future
health of America's youth.
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- In addition to boosting health, such initiatives could
save considerable amounts of healthcare dollars. The CDC put the annual
cost of treating diabetes (90%-95% of people with diabetes have type 2,
with type 1 diabetes accounting for the remainder) at $98 billion in 1997,
the latest year for which data are available. Those costs include doctor
visits, medications and hospitalization in addition to indirect costs such
as short-term disability and premature death.
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- Bernstein estimates that over the next 25 years, the
number of Americans with diabetes will rise to 50 million from the current
16 million. The cost of treating people with diabetes will amount to about
$1 trillion annually, with patients with type 2 diabetes accounting for
the bulk of these costs, he said.
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- ``Children are simply one part of it,'' the diabetes
expert said.
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