Teresa Ambroz
Appearances
Health Chatter
Childhood Diabetes
Approaches to that are reducing access, right? Having policies in schools and childcare centers and sports teams so that those aren't available and water is.
Health Chatter
Childhood Diabetes
Great question, Stan, because we know that overly restricting a child's diet will, it's not good. It's actually, you know, it's counterproductive. They're more likely to have eating problems or even eating disorders. Like we do not want to do that. As a dietician, you know, I would, be very obvious. I love chocolate chip cookies. You know, it's not a horrible thing.
Health Chatter
Childhood Diabetes
It's good for your mental health to be enjoyed. And it's how often and how much not giving like special meaning or feeling like they're bad foods. But focusing on just enjoying food and, and, you know, having a whole foods diet and role modeling, you know, so that it's not the norm to just have pizza and soda for every party.
Health Chatter
Childhood Diabetes
You know, if you're planning a school party for your kids, you can make really fun fruit kebabs. Kids can love, love those kinds of things and enjoy it. So it's not making, you know, one food good or bad, but just putting more high quality foods in the environment and role modeling.
Health Chatter
Childhood Diabetes
Great question, Stan. The U.S. is seeing growing rates of both obesity and type 2 diabetes and in children, some alarming rates, especially in African-American youth. Minnesota's actually, you know, overall has slightly lower rates of diabetes and lower rates of obesity because there's a lot of really good things happening in our communities. Our community are stepping up.
Health Chatter
Childhood Diabetes
Um, there's efforts to, to get healthier, um, kids restaurant meals where every kid's meal isn't a fried food and a sugary drink. Um, you know, we can make those kinds of policies as communities, um, And there's a lot of work going on with the statewide health improvement partnership. Some of our hospitals and care systems and organizations are working at the community level to make changes.
Health Chatter
Childhood Diabetes
There's a lot of community groups that are really concerned about this, trying to make it easier for people to make the healthy choice. So by influencing little P policies, like will our faith-based organizations you know, serve some fruit when we kind of congregate or, you know, there's a lot of different efforts going on.
Health Chatter
Childhood Diabetes
Yeah. Everybody kind of assumed that, but the studies are showing that it really affects your metabolic health. So when we're talking about obesity or too much weight for height, what we're really concerned about is health. People come in all shapes and sizes and we want to avoid weight stigmatism or weight bias. But when we're looking at trying to
Health Chatter
Childhood Diabetes
address it and make healthier choices and reduce the sugar in our diets, turning to sugary drinks, even artificially sweetened sugary tasting drinks seems to affect our hormones, our gut microbiome. And we see higher metabolic health issues and the associations with chronic conditions, but especially for kids, they're growing, they're smaller bodies. We don't want to expose them to, um,
Health Chatter
Childhood Diabetes
chemicals that we really don't understand the long-term effects of. So it could give them a preference for sweeter foods and make them more likely to over-consume sweets. So really focusing on water and low-fat or skin milk is really the approach.
Health Chatter
Childhood Diabetes
Yeah, definitely. If you have a family member who has had type 2 diabetes, you're going to be at higher risk of developing type 2 diabetes.
Health Chatter
Childhood Diabetes
Yeah, definitely is hitting the African-American community and, um, our American Indian community exceptionally hard. Um, other communities like Latinx community, um, and people of color in general. Asian communities sometimes will have like, will experience diabetes with less body weight. So at a lower body weight, they seem to be at higher risk.
Health Chatter
Childhood Diabetes
So there are definitely differences, but a lot of the differences are also associated with social determinants of health, where you live, work, learn, play that back to that toxic environment.
Health Chatter
Childhood Diabetes
You know, we look at our Minnesota student survey, people of color, communities of color, children of color are drinking more sugary drinks, a lot more, but that's not because, you know, it's more environmental and there's a lot more advertising targeted to people of color. African-American children see twice as many ads on TV.
Health Chatter
Childhood Diabetes
If you drive through certain communities, you'll see billboards and fast food restaurants for unhealthy foods. So I'll pause there. I see Gary.
Health Chatter
Childhood Diabetes
Yes. So in my previous role as a nutritionist, I work with corner stores. We worked with local public health to try to increase access to healthy foods in corner stores and neighborhoods. Those food deserts are a real problem. Food insecurity is associated with obesity and type 2 diabetes. So we do need to address that. And we need to make sure people get good quality food.
Health Chatter
Childhood Diabetes
So there's a super shelf initiative that's really worked across the state with getting healthy, good quality food into food shelves. So when people visit, the first thing they see are fruits and vegetables. It's not taking away choice. It's encouraging. It's just making good, appealing foods easier. and accessible for everyone.
Health Chatter
Childhood Diabetes
So, you know, checkout lanes, we've all had that experience of seeing or having our own children nag us at the checkout lane. They want that treat. That's marketing. Marketing is product price, placement, promotion. They're putting it everywhere we are. And so we can have policies to try to limit that or work with stores to ask them to not have
Health Chatter
Childhood Diabetes
Some of those things at the checkout lane or at least have some healthy choices there too. It's hard because there's a lot of economic forces working against that. Julie, I'll let you add what you want.
Health Chatter
Childhood Diabetes
Yeah. There's so many things. And back to, you know, what Dr. Bain said as well, Clarence, and what you're saying is, you know, there's a childhood experience. obesity interventions cost-effectiveness study that Harvard has led.
Health Chatter
Childhood Diabetes
It's called the Choices Initiative, and you can look online, Google it, Choices and Harvard, but they've identified the most effective interventions to address childhood obesity. And things like sugary beverage excise tax, you know, will really reduce health disparities. There's some, you know,
Health Chatter
Childhood Diabetes
Some things like, you know, the policies that we have in schools about after school activity and play and making sure they're accessible to the populations experiencing the greatest health disparities so kids have a place to play and move and have access to healthy foods after school.
Health Chatter
Childhood Diabetes
There are some things that are really parent education oriented with text messages that come through the primary care provider to support parents as they're trying to navigate the remarkable pressures on their children. to make unhealthy choices through, you know, they're exposed to so much advertising.
Health Chatter
Childhood Diabetes
Like if we had a policy at a federal level about advertising to children, that would have a huge impact. And think about all the rural communities with the dollar stores moving in, the grocery stores moving out. Those communities are experiencing a lot of health disparities as well. So those are all policy level things that need to be discussed.
Health Chatter
Childhood Diabetes
So that's a great question in the media all the time, Stan. The American Academy of Pediatrics recently came out with guidelines for best practices in addressing childhood obesity. And they recommended that these lifestyle behavior programs that family healthy weight programs that Julie just was talking about earlier.
Health Chatter
Childhood Diabetes
That's part of the focus of our grant is to make those proven programs available to communities experiencing the greatest disparities and figure out which ones make the most sense with those communities. And the medications, you know, we're going to have endocrinologists who specialize in this. There are some children who are having severe health problems.
Health Chatter
Childhood Diabetes
Their weight is so great that, you know, they're having spinal problems or knees, knee problems. metabolic problems, that their lives are going to be, they're going to get things like kidney disease and blindness at much earlier ages and not have healthy lives. You know, for some of those kids, these medications are going to be really, really helpful, but they're not for cosmetic changes.
Health Chatter
Childhood Diabetes
And lifestyle change in and of itself has many, many benefits. on affecting other health conditions like hypertension and dementia. So, you know, we can't kind of forget about that. There's not really a quick fix for health. It's not just about one pill.
Health Chatter
Childhood Diabetes
So thanks for having us. We're really excited to be here talking to Stan and Clarence and Barry. So when you think about diabetes, a lot of times people think of type 1 diabetes, which isn't what we're focusing on here, which is a condition that you know, has complex origins, but type two diabetes used to be referred to as adult onset diabetes.
Health Chatter
Childhood Diabetes
So COVID, so we know People with diabetes and people with complications from diabetes had the most severe outcomes from COVID. It was really concerning, you know, really vulnerable populations. So really getting messages out for protection. But I think there's so much more work to be done here. One of the things, you know, I anticipated when that hit.
Health Chatter
Childhood Diabetes
because I've worked in childhood obesity clinics before is, you know, over the summer months, kids tend to gain weight. They have less structure. School meals with the Healthy Hunger for Kids Act are really one of the healthiest sources of food kids get. And it's great that we have free school lunch for all now. I expect that's going to have a beneficial impact on our kids.
Health Chatter
Childhood Diabetes
COVID. So kids did gain weight. Kids were dealing with stress. You know, we saw more people out walking, which is really encouraging, but we know healthy lifestyles can be beneficial for reducing risks from things like COVID. So we need to do better. We need to do more communication.
Health Chatter
Childhood Diabetes
And on that note, we will be putting out community-based grants for community to lead the way in addressing food access related issues to prevent and support people with diabetes. Because we know having nutritious, not just food security, but food and nutrition security, you know, having access to good, wholesome foods that are appealing, that are safe, that, you know, are culturally appropriate.
Health Chatter
Childhood Diabetes
So when I started my career many years ago, you just, we called it adult onset diabetes. And then I started seeing children in a clinic that I was working in, children with severe obesity, starting to be diagnosed with type two or adult onset diabetes. And it was really, really concerning. This is a type of diabetes that is considered largely preventable.
Health Chatter
Childhood Diabetes
We need to find better ways to make it easier to make a healthy choice.
Health Chatter
Childhood Diabetes
Healthcare providers are really one of the places where it's most appropriate to talk about health. and how weight's affecting a child's health. Because it's not just a cosmetic issue. You know, it shouldn't be approached as a cosmetic issue. And providers don't feel comfortable talking about this often. We did some focus groups with providers and school nurses. This is a hard topic to talk about.
Health Chatter
Childhood Diabetes
So I think more training to support the health messages, how to approach it, you know, not to contribute to disordered eating behaviors. for example, um, to not make the problem worse. So I think there's really important efforts that could go into helping equip health professionals in supporting. Yeah.
Health Chatter
Childhood Diabetes
I love it. Food prescriptions are on the policy agenda for a lot of people to try to have healthcare coverage, to write a food prescription. Why wait until they get a chronic condition? Why not help somebody before that? It's, you know, the cost effectiveness of that and the studies that we're seeing are, you know, really, it's common sense to use those types of approaches.
Health Chatter
Childhood Diabetes
And it has multiple factors that contribute to it. It's a very complex condition, but it is related to how our lifestyles, cultures have shifted, at least partially. And that's a type of diabetes that we want to talk about and how we can work to prevent it.
Health Chatter
Childhood Diabetes
So when we think about prevention of childhood obesity, we start thinking about gestation and what pregnant women are doing because There is something called gestational diabetes, which means the woman's blood sugar is above a healthy level temporarily during their pregnancy, which can affect the infant in utero.
Health Chatter
Childhood Diabetes
And that can contribute to higher risks of diabetes for that child after they're born. And after that, you know, really focusing on encouraging breastfeeding, which is also associated with health, better health for the infant and mother. and reducing risks for future diabetes. Dr. Baines, do you want to add anything?
Health Chatter
Childhood Diabetes
That is an excellent question. So we really need to focus at both the prevention level as early as possible. And then, you know, the higher risk level of treatments and interventions for folks with prediabetes, children and adults with prediabetes. But what we know is that the earlier we can prevent obesity, the more likely we are to achieve good health.
Health Chatter
Childhood Diabetes
It's really hard to reverse obesity when you already have it. And investing in prevention early in childhood is really the game changer for making a difference. I've heard one National Institute of Health leader, expert in the field, say if he had all the money in the world, he'd invest in prevention of childhood obesity.
Health Chatter
Childhood Diabetes
But the game changer, like for our diabetes program at the state, we are funded through the Center for Disease Control and Prevention, and they define the areas of work that we are paid to focus on. So until this last grant opportunity, we didn't have resources allocated to focus on childhood obesity and type 2 diabetes prevention in children.
Health Chatter
Childhood Diabetes
So we were thrilled to see that it was added, and we're thrilled to be working on it. Julie, do you want to add?
Health Chatter
Childhood Diabetes
Yeah, that's a great question. So I've had this bird's eye view as my career has been long. And you know, when I started my career in the mid 1980s, childhood obesity just started to escalate, like obesity rates just started to climb after 1980 dramatically. And type two diabetes tends to follow about 10 years behind at a population level.
Health Chatter
Childhood Diabetes
So when people are talking about these small increases in the last 10 or 20 years, we start to think that it's just inevitable that Type 2 diabetes is inevitable and 40% of people are going to have it in their lifetime. And people are going to live shorter lives than their parents. And we start to accept these to be inevitable.
Health Chatter
Childhood Diabetes
And it's not because we know that in the 1970s, four times less kids, less people had diabetes, type 2 diabetes. So, and obesity. So we can reverse these trends and to the cause it's really complicated because there is a genetic component, but there's really an environmental component that kind of makes it harder for some people not to gain weight.
Health Chatter
Childhood Diabetes
We have what we has often been referred to as a toxic environment that contributes to obesity. So if people who kind of, you know, grew up in those areas and can think about the differences, you know,
Health Chatter
Childhood Diabetes
advertising and marketing and screen time and our food environment um that let's just share i'm sure everybody's got really great examples of what they've seen barry we see yeah so yeah i wanted to you know i'm just trying to think back you know what what had started to change
Health Chatter
Childhood Diabetes
Yeah, Health Affairs has run articles about some of these things. So one of the big players have been big changes that we've seen results with are changes in the WIC food packages. where instead of giving kids fruit juice, you're giving them whole fruits, for example. So the quality of the food and less processed foods, ultra processed foods are a huge factor.
Health Chatter
Childhood Diabetes
Sugary beverages have dramatically increased in consumption overall, and the trends are pretty parallel, and they're associated with increased rates of type two diabetes and cardiovascular disease and cavities.
Health Chatter
Childhood Diabetes
And so sugary drinks, you know, include things like sports drinks and lemonade and Kool-Aid, you know, these flavored waters that have even artificial sweeteners are associated with metabolic conditions. So trying to encourage consumption of water and milk, low fat milk for children and adults, um, no sugary beverages are recommended before age five.
Health Chatter
Childhood Diabetes
And even if kids are going to consume them, you know, occasionally one eight ounce drink a week, like people are consuming far, far too much sugar. And that can make a big difference because when you consume sugary drinks, it doesn't satiate your hunger. You still feel hungry and you can eat a lot of food. So that is a huge change people could make. And some,