Field Notes

Childhood Obesity Task Force Must Focus on Treating Minority Children

The White House Task Force on Childhood Obesity, created by the president as part of the Let’s Move! campaign, aims to solve the childhood obesity epidemic within a generation, returning the country to a rate of 5% obesity by 2030, which was the rate before childhood obesity first began to rise in the late 1970s.

In a recent University of Michigan (U-M) study, published online in Obesity Journal, researchers evaluated the balance of prevention and treatment required for achieving goals laid out by the task force’s May 2010 report.

To achieve this goal, researchers conclude that a shared emphasis on both obesity prevention and treatment strategies is required. Prevention programs alone can’t appropriately tackle the epidemic affecting children who are already obese, particularly minorities. Obesity treatment strategies need to be a key part of the equation.

“There’s a lot of discussion about obesity prevention for children. That’s certainly important, but it’s not the whole story. Because so many children are already obese, there needs to be greater efforts focused on treatment if we’re going to have success,” says lead study author Joyce M. Lee, MD, MPH, an assistant professor of pediatrics and communicable diseases at the U-M Medical School and a clinician at U-M C. S. Mott Children’s Hospital.

Rates of childhood obesity in the United States are much higher for minority children, with 20% of black and Mexican American children affected compared with 15% of white children. Because the burden of obesity is already so high, prevention strategies alone will not help the task force reach its goal, the study concludes.

“Effective treatment strategies, particularly targeted to minority children, are especially needed,” Lee says.

The study points out that recent legislation, including the Healthy, Hunger-Free Kids Act of 2010, may help progress efforts to reverse the obesity epidemic. The act increased financial support for the National School Lunch Program, which offers free or reduced-price meals to low-income students.

However, researchers say the law may have a greater impact on preventing obesity in healthy children rather than reducing obesity in children already affected by the condition.

“It won’t be enough just to develop new, culturally relevant and effective treatment strategies focused on minority children. We must reduce the financial barriers to these treatment strategies for kids in low-income households, many of whom are from racial/ethnic minority groups,” Lee says.

— Source: University of Michigan Health System

 

Intensive Glucose Control Fails to Improve Cognitive Decline in Older Diabetes Patients

Intensive control of blood sugar levels beyond standard targets provides no additional protection against cognitive decline in older people with diabetes than standard treatment, according to a national study coordinated by researchers at Wake Forest Baptist Medical Center.

The first results of the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) study appear online in The Lancet Neurology.

“We know that people with type 2 diabetes have a much higher risk of dementia and memory loss than people without diabetes,” says Jeff D. Williamson, MD, chief of the department of geriatrics and gerontology and principal investigator of the study’s coordinating center at Wake Forest Baptist. “What we didn’t know was, if you intensively control blood sugar levels in people who have had a history of trouble controlling them, does the added cost and effort to control blood sugar result in a slowed rate of memory loss? After conducting this study, there remains no evidence that it does.

“We also learned, however, that the intensive blood sugar control does preserve brain volume,” adds Williamson, director of the Roena Kulynych Center for Memory and Cognition Research at Wake Forest Baptist. “What that means for the long-term preservation of cognitive function of these patients, we’re still trying to figure out.”

The ACCORD-MIND trial is a national study sponsored by the National Heart, Lung, and Blood Institute designed to examine the effects of different glucose-lowering strategies on the risk for cardiovascular disease.

To determine whether intensive blood glucose control would improve cognitive outcomes, the research team recruited nearly 3,000 people with long-standing type 2 diabetes and a high risk of heart disease for the study. Each was assigned either to an intensive program to maintain their hemoglobin A1c lower than standard targets at below 6% or to a standard program to maintain the levels between 7% and 7.9%. The patients ranged in age from 55 to 80 years old.

All the participants underwent cognitive testing, and more than 600 people also received MRI scans to measure any change in brain volume during the study.

The initial study plan was to measure the participants’ cognitive ability (through cognitive tests) and brain volume (through MRI) after 40 months, but an increased risk of dying in the intensive strategy group led the researchers to switch all the participants to the standard glucose-lowering strategy at a median treatment time of 39 months.

Cognitive test scores revealed no difference between the groups. People in the intensive treatment group had larger total brain volume. However, this result, when weighed against the lack of cognitive benefit, the increased risks of cardiovascular problems, and increased mortality in the intensive treatment group, did not support use of the more intensive therapy, the researchers concluded.

“While these findings do not support the use of intensive therapy to reduce the possible effects of diabetes on the brains of older people, it remains important for older adults with type 2 diabetes to continue well-established regimens to keep their blood glucose levels under control,” says lead author Lenore J. Launer, PhD, of the National Institute on Aging. “Cognitive health is of particular concern in type 2 diabetes. We will continue to investigate how managing blood sugar levels might be employed to protect people with diabetes from increased risk of cognitive decline as they age.”

“It is important to note that the average person in this study had type 2 diabetes for more than eight years and had demonstrated difficulty in controlling their blood sugar,” Williamson says. “Today, many people like this with diabetes spend lots of money, time, and energy worrying about and trying to drive their blood sugar levels down lower than recommended goals, but we’ve already shown that using lots of medication to do this does not help prevent heart attacks. This result on memory gives added guidance to those people and some relief from that pressure to take more and more medication. Now, they will be able to focus their attention and money on other things to improve their overall health, such as diet, exercise, and behavioral interventions that may work to preserve memory and reduce heart disease.”

— Source: Wake Forest Baptist Medical Center