An intervention in middle schools lowered the obesity rate in students at highest risk for type 2 diabetes, those who started out overweight or obese in sixth grade, an NIH-funded study has found. However, schools that implemented the program did not differ from comparison schools in the study's primary outcome—the prevalence of overweight and obesity combined—which had declined 4 percent in both groups of schools by the end of the three-year study.
The goal of the HEALTHY Study was to determine whether changes in school food services; longer, more intense periods of physical education; and classroom activities to promote behavior change would lower risk factors for type 2 diabetes. Conducted from the beginning of the sixth grade to the end of the eighth, the study involved 4,600 students attending 42 middle schools in seven areas of the country. Schools were randomly assigned to implement the program or serve as a comparison school.
"The study shows that a school-based program can help lower obesity and certain risk factors for type 2 diabetes in youth at high risk for the disease," said Griffin P. Rodgers, M.D., director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Researchers were surprised to find that the number of overweight and obese students had declined in comparison schools as well as program schools. "The decline in the number of overweight and obese children in comparison schools was a welcome but unexpected finding," said study chair and lead author Gary D. Foster, Ph.D., of Temple University, Philadelphia.
"Future analyses will try to clarify the reasons for the improvement in these schools. For example, we'll look at the comparison schools to see if they made healthy changes to the school environment because of increased awareness about the problem of childhood obesity."
The intervention significantly lowered the obesity rate among children whose body mass index, or BMI, was initially at the 85th percentile or more. In children, overweight is defined as a BMI at the 85th to 94th percentile for their age and sex; obesity is defined as a BMI at the 95th percentile or more. BMI is a measurement of weight in relation to height.
Students in program schools who were overweight or obese in the sixth grade had 21 percent lower odds of being obese by the end of the eighth grade compared with students in control schools. Nationally, about one-third of children are overweight or obese, but in schools participating in the study, half of students were overweight or obese in sixth grade.
"Decreasing the number of obese children can have profound effects on diabetes risk in young people, since obese youth are at greatest risk of metabolic abnormalities," Foster said.
At the end of the study, 35 percent of children in both intervention and comparison schools with a BMI in the 95th percentile or greater had high insulin readings, compared with 2 percent of students whose BMI was less than the 85th percentile.
The program also lowered average levels of fasting insulin and the number of students with a waist at or over the 90th percentile in students in intervention schools compared with comparison schools. A high blood level of insulin after an overnight fast and a large waist increase the risk of developing type 2 diabetes, independent of body weight. However, the two groups did not differ in mean glucose levels or the percentage of students with elevated fasting glucose. A higher-than-normal level of fasting blood sugar indicates a greater risk of developing type 2 diabetes.
The results of the HEALTHY Study appear online in the New England Journal of Medicine June 27, 2010, and coincide with presentation of the results at the 70th annual scientific sessions of the American Diabetes Association (ADA) in Orlando, Fla. The study was funded by the NIDDK, a part of the National Institutes of Health, and the ADA.
"We will only stop the diabetes epidemic if we continue to test innovative approaches to help children make healthy lifestyle choices," said Richard M. Bergenstal, M.D., president, Medicine and Science, ADA. "The HEALTHY Study shows us an effective approach that can be implemented to improve the outcomes of a large number of youth at very high risk of diabetes."
Because type 2 diabetes disproportionately affects minorities and low-income people, the study was conducted in schools with a high enrollment of minority children (54 percent Hispanic and 18 percent African-American) and youth from low-income families. About 75 percent of students were eligible for free or reduced-price meals.
At the beginning of sixth grade, many students had signs of high diabetes risk. Nearly half were overweight or obese, 16 percent had elevated fasting blood glucose levels, and nearly 7 percent had elevated fasting insulin levels. At the end of the eighth grade, students were tested for diabetes risk factors, including fasting blood levels of glucose, insulin, and lipids as well as height, weight, blood pressure, fitness level, and waist circumference.
The program consisted of
- Healthier choices in the cafeteria, snack bars, class events, and vending machines (lower fat, higher fiber foods; more fruits and vegetables; and an emphasis on water, low-fat milk, and drinks with no added sugar)
- Longer, more intense periods of physical activity, defined as achieving a heart rate of at least 130 beats per minute, with a target of 150 minutes or more over a 10-day period
- Activities and awareness campaigns that promoted long-term healthy behaviors.
The study was conducted by researchers at the following centers:
- Baylor College of Medicine, Houston, Texas
- University of California, Irvine
- University of North Carolina at Chapel Hill
- Oregon Health and Science University, Portland
- Temple University, Philadelphia
- University of Pittsburgh Medical Center
- University of Texas Health Science Center at San Antonio
- George Washington University, Washington, D.C. (Coordinating Center)
About 24 million people in the United States have diabetes. It is the main cause of kidney failure, limb amputations, new onset blindness in adults and a major cause of heart disease and stroke. The longer a person has diabetes, the greater the chances of developing serious damage to the eyes, nerves, heart, kidneys, and blood vessels.
Type 2 diabetes, which accounts for up to 95 percent of all diabetes cases, becomes more common with increasing age. The disease is strongly associated with obesity, inactivity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, and racial or ethnic background. The prevalence of diagnosed diabetes has more than doubled in the last 30 years, due in large part to the upsurge in obesity. For more information about diabetes, visit http://diabetes.niddk.nih.gov/index.htm.
More than two-thirds of U.S. adults age 20 and older are overweight or obese. Among youth 2 to 19 years old, about one-third have a BMI at or above the 85th percentile for their age. Once seen only in adults, type 2 diabetes has been rising steadily in youth. The SEARCH for Diabetes in Youth Study, funded by the Centers for Disease Control and Prevention and the NIH, is examining diabetes rates in youth. According to the SEARCH Study, from 2002 to 2005
- About 3,700 youth from less than one year of age to 19 years old were newly diagnosed with type 2 diabetes annually
- The rate of new type 2 diabetes cases in youth ages 10 to 19 years was 5.3 per 100,000, with higher rates in minority populations.
The NIH sponsors We Can! Ways to Enhance Children's Activity and Nutrition— a program to prevent childhood obesity that encourages parents and children to adopt healthy eating habits, increase physical activity, and reduce leisure "screen time" to prevent childhood obesity. We Can! materials, including fact sheets, brochures and curricula for adults and children, are available at http://wecan.nhlbi.nih.gov or by calling toll-free 1-866-35-WECAN.
NIDDK, part of the NIH, conducts and supports basic and clinical research and research training on some of the most common, severe and disabling conditions affecting Americans. The Institute's research interests include diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic and hematologic diseases. For more information, visit www.niddk.nih.gov.
The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
- Information about the HEALTHY Study (NCT00458029) can be found at www.clinicaltrials.gov.
- Questions and Answers about the HEALTHY Study http://www2.niddk.nih.gov/Research/ClinicalResearch/HEALTHY/QandA.htm
- HEALTHY Study website http://www.healthystudy.org/
- National Diabetes Information Clearinghouse http://diabetes.niddk.nih.gov/
- National Diabetes Education Program http://ndep.nih.gov/
- "Solving the Problem of Childhood Obesity within a Generation." White House Task Force on Childhood Obesity: Report to the Presidenthttp://www.letsmove.gov/taskforce_childhoodobesityrpt.html
- "Let's Move," First Lady Michelle Obama's campaign to end the childhood obesity epidemic in a generation http://www.letsmove.gov/
Contacts and sources: