From MedpageToday.com

Eating regular meals with the family may keep teenage girls from extreme weight control measures such as purging, according to a longitudinal study.

Girls who ate with their family most days of the week were 29% less likely to engage in purging or to use diet pills and diuretics five years later, even after adjusting for confounding factors, Dianne Neumark-Sztainer, Ph.D., M.P.H., R.D., of the University of Minnesota here, and colleagues reported in the January issue of Archives of Pediatrics & Adolescent Medicine.

Binge eating and other disordered eating behaviors also tended to be less common for those accustomed to eating meals with their family, the researchers said.

Action Points

Explain to interested patients that this study supports the role of family meals in helping teens make healthy decisions about food.

Consider suggesting ways families can increase the number of meals they eat together, such as trying breakfast if dinner does not work because of scheduling.

The prospective findings add to a growing body of literature suggesting family meals play an important role in the health and well-being of adolescent girls.

“Health care professionals have an important role to play in reinforcing the benefits of family meals,” they said.

Without being judgmental, providers can help families set realistic goals and come up with creative ways to increase frequency of meals together, Dr. Neumark-Sztainer added.

“This may be eating breakfast together if dinner doesn’t work,” she suggested. “It can be challenging, I just think we have to put it up there with our priorities.”

The researchers’ Project EAT (Eating Among Teens) study had previously shown that extreme weight control behaviors increased in prevalence from 14.5% to 23.9% as the girls progressed from middle to late adolescence.

These behaviors can cause physical and psychological problems, including weight gain, depressive symptoms, and the onset of eating disorders, they noted.

The second, longitudinal, phase of Project EAT followed 1,386 female and 1,130 male middle and high school students from 31 Minnesota schools for eating patterns and weight-control related behaviors.

Whereas the first phase used in-class surveys and anthropometric measures during the 1998-99 school year, the second surveyed just over half of the original participants by mail during the 2003-04 academic year.

A third of the participants were in middle school (mean age 12.8) in the 1998-99 phase; the rest were high schoolers (mean age 15.8).

Disordered eating behaviors at five-year follow-up were more common among girls than boys, and the effect of baseline family meal patterns was different between genders.

In unadjusted analyses, girls who reported at least five family meals a week had significantly lower prevalence of all types of disordered eating behaviors.

Compared with girls who reported fewer than five weekly family meals, prevalence was:

17.4% versus 26% for extreme weight-control behaviors, including self-induced vomiting and use of laxatives, diet pills, or diuretics (P0.001)

57.4% versus 64.4% for unhealthy weight control behaviors, defined as fasting, eating food substitutes or “very little” food, skipping meals, and smoking more cigarettes (P0.008)

9.2% versus 12.7% for binge eating (P0.046)

13.9% versus 18.5% for chronic dieting (P0.02)

After adjustment for sociodemographics and body mass index, regular family meals were associated with lower odds of extreme weight control behaviors (odds ratio: 0.66, 95% CI: 0.49 to 0.88, P0.005) and a trend for less unhealthy behaviors (OR: 0.80, 95% CI: 0.63 to 1.02, P0.07) and chronic dieting (OR: 0.75, 95% CI: 0.55 to 1.03, P0.07).

The association with extreme weight-control behaviors remained after additional adjustment for family connectedness and parental encouragement to diet (OR: 0.69, 95% CI: 0.51 to 0.94, P0.02) and for baseline behaviors (OR: 0.71, 95% CI: 0.52 to 0.97, P0.03).

Trends for the other disordered eating behaviors continued to suggest a protective effect of family meals.

Among boys, family meals had little impact on disordered eating.

However, there was an unexpected increase in unhealthy weight control behaviors for boys who regularly had meals with family (OR: 1.73, 95% CI: 1.24 to 2.40, P0.001). This increase was limited to skipping meals (OR: 1.81, 95% CI: 1.24 to 2.63) and eating very little food (OR: 1.84, 95% CI: 1.23 to 2.69).

The gender difference could be because adolescent boys and girls have different experiences at family meals, Dr. Neumark-Sztainer and colleagues speculated.

“Family meals may offer more benefits to adolescent girls, who may be more sensitive to and likely to be influenced by interpersonal and familial relationships than are adolescent boys,” they wrote.

Another factor could simply be that disordered eating is less common among boys, Dr. Neumark-Sztainer said.

However, they cautioned, the findings could have been limited by attrition from the original study population and the use of brief measures of disordered eating behaviors and lack of clinical measures of eating disorders.

Family meals may not be the only factor that impacts development of disordered eating behaviors, Dr. Neumark-Sztainer said.

“All we can say from this is the association is very strong,” she said.

From USATODAY.com

Lilly Branka, 5, a kindergartner in Medfield, Mass., and Richard Zarate, 12, a seventh-grader in San Antonio, live in different worlds, but they have something in common: diabetes.

Until recently, almost all children had the type of diabetes Lilly has: type 1, the form of the disease caused by the immune system’s destruction of cells in the pancreas that produce insulin. People with type 1, who account for 5%-10% of those with diabetes, require daily injections of insulin to survive.

Richard and a growing number of children and teens have the more common form of diabetes, type 2, which used to be called adult-onset diabetes because it did not occur in children.

But the nationwide trend toward more high-fat food and less high-activity play has run smack into a genetic predisposition for diabetes in some communities, especially those with large Latino populations, sparking what pediatrician Jane Lynch of the Texas Diabetes Institute calls a “very scary, very alarming” epidemic of type 2 diabetes in children.

“We have close to 300 children we follow with type 2 diabetes,” some as young as 7, Lynch says. “When I trained in the early ’90s, it was essentially unheard of.”

The increasing incidence of diabetes in children threatens to offset the benefits of improved diabetes treatment that have led to reductions in many of the disease’s deadly or disabling complications.

Richard is being treated at the diabetes institute as part of a national study, Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY), and his mother, Christine Zarate, who also has diabetes, is grateful.

She had long suspected her only child, who she says always has been overweight, might also have the disease, because he had an area of darkened skin on the back of his neck, a marking doctors call acanthosis nigricans. It is often caused by high levels of insulin, which can occur when people are overweight and their bodies don’t use insulin efficiently. The body tries to compensate for that by churning out extra insulin.

Zarate, who works as a private nurse, says she recognized the discoloration and knew what it meant. “I’ve tried to get him diagnosed since he was about 6 or 7, but the pediatrician he had at that time

I didn’t have insurance

she never did a blood test on him.”

Two years ago, at age 10, Richard began having symptoms, such as unusual thirst and frequent urination, and his mother checked his blood with her own glucose meter. The reading indicated Richard’s blood sugar level was about five times higher than normal. She took him to the emergency room, where he was diagnosed and given insulin. They were told to see a diabetes specialist, but local doctors had months-long waiting lists.

The diabetes institute “was a godsend,” Zarate says. As a participant in a clinical trial, Richard gets free diet and exercise counseling, medications and regular checkups. He is “doing wonderful,” his mom says. He’s taking two medications but is off insulin. “He’s real careful, watches his carbs,” she says. But “he’s still a kid who wants to eat a hamburger.”

Bleak future for type 2 kids

For doctors, type 1 diabetes is familiar in children, but treating kids with type 2 is uncharted ground. Only insulin and the drug metformin are approved for use in children, but insulin as a first-line treatment can cause weight gain in kids who already are overweight, Lynch says, and metformin alone is often not enough.

In one arm of the TODAY study, children, including Richard, are given metformin and Avandia, a drug that improves the body’s ability to respond to insulin and appears also to preserve the functioning of cells in the pancreas that produce the hormone. But Avandia has been linked to an increased risk of heart attack in adults. That hasn’t been seen so far in children, she says, but they’re being closely monitored.

“It’s alarming to be in the midst of this,” she says. “We are seeing here 7-year-olds, 8-year-olds with pure type 2 diabetes. They’re very obese, and within five years, we’re seeing kidney complications, we’re treating 10-year-olds for hypertension, high lipids and having to see how (the drugs to treat those conditions) interact with diabetes.”

Lynch predicts that by the late teens, many children with type 2 diabetes will be facing health problems that a generation ago didn’t occur until midlife.

“We have children with declining (kidney) function who are 17,” she says. “We’ve had kids on multiple drugs for high blood pressure who are 18. We find ourselves using a lot of adult medications,” and studies have not been done to assure their safe use in children. “This has been a huge, scary learning curve for us in this study. We keep venturing further and further out on that limb.”

Diet and exercise counseling have proven successful in the trial, but insurance companies may not cover the cost of a nutritionist or diabetes educator, “and it takes intensive education and reinforcement” to cause behavior changes, Lynch says.

“We definitely underestimate the degree of psychological and nutritional nursing support it takes to keep these kids on track.”

A new wrinkle is that some children appear to have symptoms of both type 1 and type 2 diabetes, a hybrid known as double diabetes.

Dorothy Becker, chief of pediatric endocrinology and diabetes at Children’s Hospital in Pittsburgh, who coined the term, says it’s a combination of the failure of insulin-producing cells that is a hallmark of type 1, and insulin resistance, which is associated with obesity in type 2. If a child with type 1 diabetes is also overweight, whatever remaining insulin-producing cells are still functioning can’t keep up with the greater need for insulin.

Schools get involved

Becker says her team has found up to 30% of type 1 children are overweight at the time of diagnosis and have characteristics of type 2 diabetes, including high blood pressure and high cholesterol. “This has increased over the last two decades,” she says, the same time period when the national waistline has been expanding.

The Centers for Disease Control and Prevention, which is tracking diabetes in children, last year reported about 154,000 children have been diagnosed, the majority with type 1. How many remain undiagnosed is not clear, but doctors say both forms are increasing, and schools have noticed, too.

Many have taken steps to ensure that kids with diabetes get the support they need. The American Diabetes Association’s Safe at Schools program trains teachers and school nurses to help young children monitor their blood sugar levels and administer insulin.

At Memorial School in Medfield, outside Boston, nurse Mary Ellen Zappulla went through the program earlier this month at the Joslin Diabetes Center to brush up the skills needed to help Lilly, one of two children with type 1 diabetes in the kindergarten class.

Each day, Lilly reports to Zappulla’s office to get her blood sugar level tested and to adjust her insulin pump as needed.

“This is the first little girl I’ve had with an insulin pump,” says Zappulla, who hasn’t had any problems with the procedure. “These little ones are very knowledgeable” about their disease, she says. “She’s very aware of her body” and knows when her sugar levels are off track.

But just in case, Lilly’s teacher carries a radio device to call the nurse if needed.

In the Bronx section of New York, Montefiore Medical Center operates clinics in 15 schools where students are screened and treated for diabetes. The largest school health program in the country, it provides medical care to 15,000 students, and as part of a community health effort, it offers weekend and after-school nutrition, cooking and walking programs for students and their families.

“A big focus is prevention of obesity and exercise,” says pediatrician John Leo. “We’ve opened a food co-op in the South Bronx, making available healthy food choices to the community,” but it’s “not a quick fix.”

“We can diagnose overweight, screen for diabetes, strategize a plan to maintain or lose weight, but what’s really important is educating the students and family about risk factors for diabetes and metabolic syndrome,” a cluster of symptoms that puts someone at risk for heart disease, Leo says. “A lot of parents are not even aware their child is overweight.”

The perils of processed food

There are plenty of overweight kids in San Antonio, too, Richard’s mom says. “They’re obese because of the way people eat here. Too much fast food, and the Mexican foods we have here are made with too many processed things.”

Zarate encourages Richard to take care of himself, but “trying to get him to eat vegetables takes an act of God and Congress.”

Nor is he much for sports. “He’s a video-game nut. I say, ‘You want to sign up for basketball?’ He’ll say no.” Her sister tries to get him to walk around the apartment building, “and he complains the whole time.”

But doctors at the clinic have been impressed that Richard is “so cooperative. He takes care of himself,” Zarate says. “It’s because when he’s not taking care of himself, he doesn’t feel good. I said, ‘It’s up to you.’ “

From New York Times

Federal lawmakers are considering the broadest effort ever to limit what children eat: a national ban on selling candy, sugary soda and salty, fatty food in school snack bars, vending machines and

la carte cafeteria lines.

Whether the measure, an amendment to the farm bill, can survive the convoluted politics that have bogged down that legislation in the Senate is one issue. Whether it can survive the battle among factions in the fight to improve school food is another.

Senator Tom Harkin, Democrat of Iowa and the chairman of the Agriculture Committee, has twice introduced bills to deal with foods other than the standard school lunch, which is regulated by Department of Agriculture.

Several lawmakers and advocates for changes in school food believe that an amendment to the $286 billion farm bill is the best chance to get control of the mountain of high-calorie snacks and sodas available to schoolchildren. Even if the farm bill does not pass, Mr. Harkin and Senator Lisa Murkowski, Republican of Alaska, a sponsor of the amendment, vow to keep reintroducing it in other forms until it sticks.

They are optimistic about their chances because there is more public interest than ever in improving school food and because leaders in the food and beverage industry have had a hand in creating the new standards.

But that intense corporate involvement, along with exemptions that would allow sales of chocolate milk, sports drinks and diet soda, has caused a rift among food activists who usually find themselves on the same side of school food battles.

This pits ideals about what children should eat at school against the political reality of large food corporations insisting their foods be available to children at all times, said Marion Nestle, a professor at New York University and the author of two recent books on food politics and diet. The activists want vending machines out of schools completely. Dr. Nestle has taken no public stand on the measure.

The nutrition standards would allow only plain bottled water and eight-ounce servings of fruit juice or plain or flavored low-fat milk with up to 170 calories to be sold in elementary and middle schools. High school students could also buy diet soda or, in places like school gyms, sports drinks. Other drinks with as many as 66 calories per eight ounces could be sold in high schools, but that threshold would drop to 25 calories per eight-ounce serving in five years.

Food for sale would have to be limited in saturated and trans fat and have less than 35 percent sugar. Sodium would be limited, and snacks must have no more than 180 calories per serving for middle and elementary schools and 200 calories for high schools.

The standards would not affect occasional fund-raising projects, like Girl Scout cookie sales.

Although states would not be able to pass stronger restrictions, individual school districts could.

The rules have the support of food and drink manufacturers, including the American Beverage Association, which worked closely on the amendment with Mr. Harkins office and the Center for Science in the Public Interest, an advocacy group that has been critical of the food industry.

This whole effort has momentum because of the variety of interests that have come together who do not usually find agreement, said Susan Neely, president of the beverage association.

Some parents and nutritionists are angry that states will not be able to enact even tougher limits.

My little fights in school districts are just going to be harder and harder because theyll say, Well, here are the federal guidelines, said Dr. Susan Rubin of Chappaqua, N.Y., a nutritionist who helped found the Better School Food advocacy group.

Its crazy to think we are going to fix childrens health just by letting companies sell schoolchildren smaller portions of Gatorade and baked chips, she said.

Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest, has long been a critic of companies that produce food that she considers unhealthy and of government policy toward them.

That is why some of the centers allies were surprised that Ms. Wootan had worked so closely with manufacturers on the standards. Conversely, she was surprised to find herself on the defensive for finally arranging food limits that actually have a good chance at becoming law.

I do not understand why some groups would try to stand in the way of legislation that is going to get soda, snack cakes and other high-fat, high-salt food out of virtually all schools, she said.

From WashingtonPost.com

Being overweight as a child significantly increases the risk for heart disease in adulthood as early as age 25, according to a large new study that provides the most powerful evidence yet that the obesity epidemic is spawning a generation prone to serious health problems later in life.

The study, of more than 276,000 Danish children, found that those who were overweight when they were 7 to 13 years old were much more likely to develop heart disease between the ages of 25 and 71 — even those who were just a little chubby as kids, and possibly regardless of whether they lost the weight when they grew up.

“This is incredibly important,” said Jennifer L. Baker of the Institute of Preventive Medicine in Copenhagen, who led the research, being published today in the New England Journal of Medicine. “This is the first study to convincingly show that excess childhood weight is associated with heart disease in adulthood, or with any significant health problem in adulthood.”

The study was published with an analysis of U.S. health statistics that projects teenage obesity will raise the nation’s rate of heart disease by at least 16 percent by the year 2035, causing more than 100,000 additional cases.

“This offers a frightening glimpse of what we have in store,” said David S. Ludwig of Harvard Medical School, who wrote an editorial accompanying the studies. “The epidemic of childhood obesity is not a cosmetic problem. It can have profound long-term consequences for adult illness and death.”

The proportion of U.S. children who are overweight has tripled since 1976 and now totals more than 9 million. The sharp rise has already caused a jump in children developing Type 2 diabetes, which used to be known as adult-onset diabetes because it occurred almost exclusively among adults. Children are also increasingly being diagnosed with high blood pressure and cholesterol, which raised fears they will be more likely to develop heart disease — the nation’s leading cause of death.

Previous studies had produced mixed results. “Although studies have hinted there may be an association, none has been able to confirm it,” Baker said. “They didn’t have the power to show the association.”

Baker and her colleagues analyzed information collected about the height and weight of 276,835 Danish schoolchildren between 1955 and 1960 and scoured hospital records from between 1977 and 2001 to see which of them went on to be hospitalized for heart problems as adults.

The risk increased with any amount of excess weight in childhood, the researchers found.

“Even a few extra pounds increases the risk,” Baker said. “That’s the very frightening message from our results.”

For example, a 4-foot-1-inch boy who weighed about 61 pounds at age 7 faced a 12 percent increased risk of developing heart disease between the ages of 25 and 71, compared with a similar boy who was at the normal weight of about 52 pounds.

The greatest increased risk, however, was for the heaviest older children, the researchers found.

For example, a 5-foot-1-inch boy who weighed 121 pounds at age 13 had a 34 percent greater risk compared with a boy of the same height and age who had a normal weight of 96 1/2 pounds. The risk was 51 percent higher if the boy weighed 132 1/2 pounds.

The risk was significantly lower for those who were overweight at age 7 but not at age 13, indicating that a child who can lose excess weight while still young, and remain at a normal weight, can reduce the extra risk substantially.

“This gives us hope,” Baker said. “This really suggests that if an intervention occurs during this short period of time to help a child attain and maintain a normal weight, the risk of heart disease could be reduced.”

Because the researchers did not have data on the subjects’ adult weight, they could not definitively determine whether the increased risk was due to the effects of being overweight when young or because overweight children are more likely to become overweight adults.

“We speculate that it’s the early exposure,” Baker said. “It’s plausible that because these heavy children have these risk factors and are exposed to them early in life and continue to be exposed to them, that leads an increased risk in heart disease.”

In the second study, Kirsten Bibbins-Domingo of the University of California at San Francisco and colleagues used federal statistics from the year 2000 and other data to project that by the time today’s adolescents turn 35 in 2020, up to 37 percent of men and 44 percent of women will be obese, resulting in an additional 100,000 cases of heart disease by 2035. Bibbins-Domingo said the projections would have been even higher if the analysis had included the Danish data.

“We took a very conservative approach,” she said.

Melinda Sothern, an expert on childhood obesity at Louisiana State University in New Orleans, said the findings are disturbing because they suggest not only that overweight children experience more disease and disability in childhood but also that many are also destined to be more sickly young adults.

“Overweight children are already losing their childhood. They can’t do the same types of activities as healthy-weight children,” she said. “Now they will lose their early adulthood as well.”

Ludwig likened the childhood obesity epidemic to the threat from global warming, saying that even though hard evidence is just now emerging about the consequences of the threat, society should act more aggressively to counter the trend.

“We don’t have all the data yet. But by the time all the data comes in it’s going to be too late,” Ludwig said. “You don’t want to see the water rising on the Potomac before deciding that global warming is a problem. We need national policies to address childhood obesity, too.”

From HealthScout

Eating disorders rose significantly among American boys between 1995 and 2005, according to a study that examined weight control behaviors among high school students.

The study, based on an analysis of national data from the U.S. Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System, identified a large increase in all forms of weight control behaviors among males, including dieting, diet product use, purging, exercise and vigorous exercise.

Hispanic males were most likely to practice weight control, while white males were least likely, said the study authors, led by Y. May Chao of Wesleyan University in Middletown, Conn.

They also found a significant overall increase in dieting and diet product use among female adolescents. White females were most likely practice weight control while black females were least likely, the researchers said.

The increased weight control behavior noted in males suggests growing social pressure for males to achieve unrealistic body expectations, thus increasing the risk of body dissatisfaction and eating disorders, the study authors said.

“Considering that males have negative attitudes toward treatment-seeking and are less likely than females to seek treatment, efforts should be made to increase awareness of eating disorder symptomatology in male adolescents, and future prevention efforts should target male as well as female adolescents,” the researchers wrote.

The study was published online in the International Journal of Eating Disorders