HHS Secretary and Surgeon General Join First Lady to Announce Plans to Combat Overweight and Obesity and Support Healthy Choices

First Lady Michelle Obama, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and U.S. Surgeon General Regina Benjamin announced plans today to help Americans lead healthier lives through better nutrition, regular physical activity, and by encouraging communities to support healthy choices. At a YMCA in Alexandria, VA, they talked directly with national and local leaders, parents and health professionals about reducing overweight and obesity in adults and children.

The First Lady recently announced that she will launch a major initiative on childhood obesity in the next few weeks and has asked HHS to play a key role. Today, HHS released The Surgeon General's Vision for a Healthy and Fit Nation. In her first release to the nation, Dr. Benjamin highlights the alarming trend of overweight and obese Americans, and asks them to join her in a grassroots effort to commit to changes that promote the health and wellness of our families and communities.

"The surge in obesity in this country is nothing short of a public health crisis that is threatening our children, our families, and our future," said First Lady Michelle Obama. "In fact, the health consequences are so severe that medical experts have warned that our children could be on track to live shorter lives than their parents. The paper released today is an incredibly important step in directing the Nation's attention to solving the obesity epidemic and we do not have a moment to waste."

The prevalence of obesity has more than doubled among adults and has tripled among children and adolescents from 1980 to 2004. Currently, two-thirds of adults and nearly one in three children are overweight or obese. Increased food intake, a sedentary lifestyle, and environments that make it difficult for people to make healthy choices but easy to consume extra calories, all contribute to the epidemic of overweight and obesity. This epidemic threatens the progress we have made in increasing Americans' quality and years of healthy life.

"Curbing the obesity epidemic requires committed people and organizations across the nation working together to take action," said Secretary Sebelius. "Today, we outline a vision for the nation that requires parents, neighborhoods, the medical community, employers, schools and individuals to take a coordinated and comprehensive approach to combating overweight and obesity."

Additionally, many racial and ethnic groups and geographic regions of the United States are disproportionately affected. For instance, African American girls and Hispanic boys are more likely to be obese compared to non-Hispanic whites. Among adults, American Indian and Alaskan native adults have the highest rates of obesity. The sobering impact of these numbers is reflected in the nation's concurrent epidemics of diabetes, heart disease and other chronic diseases. Researchers warn that if trends are not reversed, our children will be seriously afflicted with medical conditions such as diabetes and heart disease in early adulthood.

"Americans will be more likely to change their behavior if they have a meaningful reward - something more than just reaching a certain weight or dress size," said Dr. Benjamin. "The real reward is invigorating, energizing, joyous health. It is a level of health that allows people to embrace each day and live their lives to the fullest without disease or disability."

The recommendations in The Surgeon General's Vision for a Healthy and Fit Nation include:

Improving our communities - Neighborhoods and communities should become actively involved in creating healthier environments. The availability of supermarkets, outdoor recreational facilities and the limitation of advertisements of less healthy foods and beverages are all examples of ways to create a healthier living environment.

Healthy Choices and Healthy Home Environments - Change starts with the individual choices Americans make each day for themselves, their families and those around them. Reducing the consumption of sodas and juices with added sugars; eating more fruits, vegetables and whole grains; limiting television time; and being more physically active help us achieve and maintain a healthy lifestyle.

Creating Healthy Child Care Settings - It is estimated that more than 12 million children ages 0-6 receive some form of child care on a regular basis from someone other than their parents. Parents should talk with their child care providers about changes to promote their children's health.

Creating Healthy Schools - To help students develop life-long health habits, schools should provide appealing healthy food options including fresh fruit and vegetables, whole grains, water and low-fat beverages. School systems should also require nutrition standards and daily physical education for students.

Creating Healthy Work Sites - Employers can implement wellness programs that promote healthy eating in cafeterias, encourage physical activity through group classes and create incentives for employees to participate.

Mobilizing Medical Communities - Medical care providers must make it a priority to teach their patients about the importance of good health. Doctors and other health care providers are often the most trusted source of health information and are powerful role models for healthy lifestyle habits.

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Type 2 Diabetes Gene Predisposes Children to Obesity

/PRNewswire/ -- Pediatric researchers have found that a gene already implicated in the development of type 2 diabetes in adults also raises the risk of being overweight during childhood. The finding sheds light on the genetic origins of diabetes and may present an avenue for developing drugs to counteract the disease, which has been on the upswing in childhood and adolescence.

Researchers from The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine published the study Nov. 23 in the online version of the journal Diabetes.

"It has been a bit of a mystery to scientists how or even if these adult diabetes genes function during childhood," said study leader Struan F.A. Grant, Ph.D., a researcher and associate director of the Center for Applied Genomics of The Children's Hospital of Philadelphia. "This finding suggests that there may be genetic activity during childhood that lays the foundation for the later development of type 2 diabetes."

Type 2 diabetes occurs either when the pancreas produces too little insulin, or when the body cannot efficiently use the insulin that is produced because the cells have become resistant. Formerly called adult-onset diabetes and still most common in adults, type 2 diabetes has been increasing sharply among children and teenagers.

Grant and study co-leader Hakon Hakonarson, M.D., Ph.D., director of the Center for Applied Genomics at Children's Hospital, investigated 20 gene variants, known as single nucleotide polymorphisms (SNPs), previously reported to be associated with type 2 diabetes. The researchers drew on a cohort of nearly 7,200 Caucasian children, aged 2 to 18 years, in an ongoing genome-wide association study of childhood obesity at Children's Hospital. Dividing the cohort randomly in half allowed the team to follow their discovery study with a replication study.

Researchers continue to unravel the complicated role of different diabetes-related genes in influencing body weight toward both lower and higher ends of the scale. The risk of developing type 2 diabetes in adulthood is often influenced by factors in the first year of life, including lower birth weight, as well as by higher body mass index (BMI) during childhood. Obesity is a well-known risk factor for type 2 diabetes.

A previous study earlier this year by the same study team found that another type 2 diabetes gene, CDKAL1, affects fetal growth and increases the likelihood that a baby will be underweight at birth.

The current study found that the gene HHEX-IDE does not affect birth weight, but makes it more likely that a child will become obese during childhood. The gene does not appear to predispose to obesity in adults, although by contributing to childhood obesity, it may set the stage for type 2 diabetes in adulthood.

Grant cautioned that HHEX-IDE accounts for only a small proportion of the genetic contribution to the risk of type 2 diabetes, so many other gene variants remain to be discovered. However, he adds, HHEX-IDE may represent an important underpinning of the disease. "Previously we thought that this gene affects insulin production during adulthood, but we now see that it may play an early role in influencing insulin resistance through its impact on body size during childhood," said Grant. "One implication is that if we can develop medicines to target specific biological pathways in childhood, we may be able to prevent diabetes from developing later in life."

The National Institutes of Health, the Cotswold Foundation and The Children's Hospital of Philadelphia supported this study.

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Study Finds Family History, Higher Incidence of Sunburns Associated With Rosacea

/PRNewswire-USNewswire/ -- Rosacea is a chronic skin condition that causes redness, swelling and vascular abnormalities, most commonly on the face, with varying degrees of severity. While the exact cause of rosacea is unknown, dermatologists are examining several characteristics shared by rosacea patients. This research could improve the general understanding of this complex disease which affects an estimated 14 million Americans.

Speaking today at the 67th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Alexa Boer Kimball, MD, MPH, FAAD, associate professor of dermatology at Harvard Medical School in Boston, presented findings from a case-controlled study of rosacea subjects compared to control subjects and the implications of her research.

"This study was building on previous photo database work that we had done in which we looked at photos of 3,000 people with and without rosacea to try to determine the prevalence of rosacea in certain populations and some of the factors that seemed to be associated with it," said Dr. Kimball. "We wanted to see whether we could validate some of these initial findings, as well as explore whether rosacea was predictive of other systemic conditions that might be related -- similar to the link between severe cases of psoriasis and other medical conditions such as diabetes and heart disease."

In this case-controlled study that built on the photo study conducted at Massachusetts General Hospital and Brigham and Women's Hospital, both in Boston, 65 rosacea subjects (age 24 to 86) and 65 controls without rosacea (age 18 to 78) underwent a facial skin exam, completed a questionnaire and had their height, weight and blood pressure measured. Blood pressure measurements, body mass indexes and questionnaire results of the two groups were compared. In general, the rosacea subjects had a moderate to severe form of the skin condition.

Comparing the data for the two study groups, Dr. Kimball found that rosacea subjects were three times more likely to have a family member with rosacea compared to the control group. Specifically, 34 percent of rosacea subjects reported a family member with rosacea vs. 10.5 percent of control subjects. When answering questions about their dermatological and medical conditions, rosacea subjects had significantly higher rates of blistering sunburns than control subjects (44 percent vs. 5.2 percent, respectively).

"Even when we did a more sophisticated analysis of the data controlling for age and gender, we found these findings were statistically significant and confirmed our previous findings," said Dr. Kimball. "Although these results are quite preliminary, they are important for future research as we start to explore these positive associations and their implications in controlling this condition."

In families with a history of rosacea, Dr. Kimball advised parents to consistently protect children from sun exposure with a broad-spectrum sunscreen with a Sun Protection Factor (SPF) of 15 or higher and to practice other sun-safe behaviors in order to minimize the risk of sunburns. From her research, it could not be determined if sunburns were a contributing factor to rosacea or if patients with rosacea were more likely to sunburn due to the nature of their skin condition. In either case, she noted that these preventative measures could help lessen the severity of rosacea.

One potential association with rosacea that Dr. Kimball noticed in her previous photo database analysis that was not found to be significant in her case-controlled study was a higher body mass index (BMI) in rosacea patients. While a BMI in the range of 18.5 to 24.9 is considered normal, the rosacea subjects in the previous photo analysis had a mean BMI of 27.6 (which is considered overweight) vs. a 24.3 mean BMI in the subjects without rosacea.

However, in the case-controlled study, the rosacea subjects had a slightly lower mean BMI of 26.6 vs. a comparable 26.1 mean BMI in the control subjects -- both of which were considered overweight.

"Future studies should explore the possible connection between a higher BMI and rosacea, as excess weight could be found to be a contributing factor to the condition," said Dr. Kimball.

Dr. Kimball advised rosacea patients to see their dermatologist to discuss the most appropriate treatment options available and factors that may be contributing to the severity of their condition.

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Overweight Siblings of Children With Type 2 Diabetes Likely to Have Abnormal Blood Sugar Levels

/PRNewswire-USNewswire/ -- Overweight siblings of children with type 2 diabetes are four times more likely to have abnormal glucose levels compared to other overweight children. Because abnormal glucose levels may indicate risk for diabetes or diabetes itself, these children could benefit from screening tests and diabetes prevention education.

Researchers from The Children's Hospital of Philadelphia published their findings today in the online edition of the Journal of Pediatrics.

"To our knowledge, previous studies have not specifically looked at the risk of abnormal glucose tolerance among siblings of children diagnosed with type 2 diabetes. This group has a unique combination of genetic and environmental risk factors," said Sheela N. Magge, M.D., M.S.C.E., pediatric endocrinologist at The Children's Hospital of Philadelphia and primary author of the study. "Clinical experience suggests that children with type 2 diabetes often have an obese sibling, which makes siblings an appropriate target for prevention trials."

The study looked at 62 children: 20 obese subjects with a sibling who had type 2 diabetes and a control group of 42 obese children. The groups were similar for age, gender, racial distribution (predominantly African American), pubertal status and body mass index over 95th percentile.

The researchers found that overweight siblings of children with type 2 diabetes had four times greater odds of having abnormal glucose levels (impaired glucose tolerance or type 2 diabetes) than other overweight children. However, investigators found no significant differences in insulin resistance, as measured by the homeostasis model assessment.

Type 2 diabetes is caused by a combination of both genetic and environmental factors. Known risks include obesity, decreased physical activity, race/ethnicity, family history and insulin resistance. Obesity decreases insulin sensitivity, as does puberty, when all adolescents experience a period of relative insulin resistance. In obese adolescents already at risk of developing type 2 diabetes, the increase in insulin resistance during puberty may be enough to unmask disease. Family history is also important; 74-100 percent of children with type 2 diabetes have a first- or second-degree relative who also has the condition.

Not all children with a family history of type 2 diabetes, insulin resistance or obesity develop type 2 diabetes, cautions Dr. Magge.

The researchers also add that identifying groups at high-risk for type 2 diabetes during childhood, such as obese siblings of children with type 2 diabetes, could help guide screening of obese children for abnormal glucose tolerance by primary care providers. This could also help to identify children who might benefit from participation in future type 2 diabetes prevention studies.

Dr. Magge's coauthors were: Nicolas Stettler, M.D., M.S.C.E., Abbas Jawad, M.Sc., Ph.D., and Lorraine E. Levitt Katz, M.D. all of The Children's Hospital of Philadelphia and the University of Pennsylvania.

The research was supported by grants from the National Institutes of Health and the National Center for Research Resources.

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Exercise Helps Overweight Children Reduce Anger Expression

Regular exercise seems to reduce anger expression in overweight but otherwise healthy children, researchers said.

The first published study on the topic looked at 208 typically sedentary 7- to 11-year-olds who participated in a 10-15 week afterschool aerobic exercise program or maintained their usual inactive routine. The Pediatric Anger Expression Scale, used to gauge common anger expressions such as slamming doors and hitting, was given before and after the program.

"Exercise had a significant impact on anger expression in children," said Dr. Catherine Davis, clinical health psychologist in the Medical College of Georgia School of Medicine. "This finding indicates that aerobic exercise may be an effective strategy to help overweight kids reduce anger expression and aggressive behavior."

The finding fits with evidence that exercise reduces depression and anxiety in children and with what's considered common knowledge that exercise helps adults manage anger, she said.

It also gives parents and other caregivers another reason to get and keep children moving. "I think it's reasonable to encourage children to exercise for a lot of good reasons," said Dr. Davis whose research on overweight children has shown regular physical activity not only reduces fatness but improves cognition and reduces insulin resistance – which can lead to diabetes.

"I think if teachers could see that exercise helps kids control their behavior and get along, they would be the top proponents of physical activity for kids," said Dr. Davis, noting that other studies suggests overweight children are more likely to be bullies and to be bullied. High levels of anger and hostility have been associated with delinquency in children, cardiovascular disease in adults and metabolic syndrome - which can lead to heart attack, stroke and diabetes - in adolescents.

The new finding, published in the November issue of Pediatric Exercise Science, appears to apply to overweight children generally, regardless of factors such as race, gender, socioeconomic status or even fitness or fatness levels, the researchers wrote. In fact, even though all participants in the exercise portion lost a significant amount of weight, they remained overweight at the study's conclusion.

With help from a five-year $3.6 million grant from the National Heart, Lung and Blood Institute, Dr. Davis already is looking to see if the finding holds in a similar group of children, who are part of a study on the impact of exercise on cognition. The goal is to determine if it was the exercise or participation in an after-school program that made the difference.

Extra attention from adults and time away from usual routines that could include disagreements with siblings and watching violence on television definitely could have a psychological impact. "With a psychological outcome like cognition or anger control, positive interaction with adults can make a big difference," Dr. Davis said.

In the published study, only the exercising children came to MCG's Georgia Prevention Institute after school. In the new study, both groups are coming to the institute, with non-exercisers enjoying arts, crafts and games. "We are trying to make it so the only difference is exercise," said Dr. Davis.

By Toni Baker
Medical College of Georgia

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