Stanley Feld M.D.,FACP,MACE

During World Diabetes Day in Dallas Dr. Ken Cooper delivered a terrific keynote address concerning observational studies he has performed. He related fitness to obesity, the early onset of childhood type 2 diabetes mellitus, academic achievement and behavior.

Dr. Cooper is passionate about eliminating obesity in children. He presented us with astonishing statistics.

“Estimated obesity rates for children 6 to 11 years old have increased from 15.1% in 1999 to 18.8% in 2004. The Department of Health and Human Services estimates that 20% of children and youth in the United States will be obese by 2010.

Washington D.C. was first in the nation with 22.6% of children age 10-17 being obese. Texas was sixth with 19.1% of children aged 10-17. Forty two percent (42%) of fourth graders and thirty nine percent (39%) of 8^th graders were obese in 2004. Seventy percent (70%) of these children will become obese adults and one in three will develop diabetes.

Type 2 Diabetes Mellitus is common in obese adults over the age of 40. A syndrome consisting of obesity, diabetes mellitus, high lipid levels and hypertension has been described and named “Metabolic Syndrome”. The incidence of coronary artery disease, strokes, end stage kidney disease and the complications of diabetes mellitus is high in patients with Metabolic Syndrome.

These illnesses are costly to the healthcare system. They are secondary to insulin resistance which is secondary to obesity. In order to save the healthcare system from bankruptcy we must have a national War on Obesity.

The obesity epidemic has spread to our children. It has led to an increasing incidence of type 2 diabetes mellitus in our children and earlier in life complications.

“It is estimated that 33% of children born after the year 2000 will develop diabetes with the incidence being higher in Hispanic and African-American children” “ It has been estimated Children developing Type 2 Diabetes before the age of 14 will have their lifespan shortened by 17 to 27 years. “

Dr. Cooper developed a Fitnessgram in 1982. It is composed a series of tests to measure fitness. He demonstrated, in 13,600 men followed for 8.6 years, that the less fit they are the higher the mortality rate. (JAMA, 1998).

He tested the fitness of over one million children. In California he tested fitness against reading and math skills in approximately 1.3 million children in grades 5,7,and 9.

He found; “only 25% of the students could pass all 6 of the Fitness tests. 43% could not walk or run 1 mile in the allotted time. “

As interesting and perhaps more important finding is that the higher the childrens’ fitness scores the higher the children’s test scores in reading and math using California’s standard test.

Children in the national school lunch program did worse in reading and math testing than children not on the free lunch program regardless the number of fitness standards achieved. The free food lunch program was not a healthy diet. The program has encouraged the obesity epidemic. I had not previously known of the school food programs relationship to scholastic achievement.

Public schools in Texas are obsessed with high achievement on the Texas Assessment of Knowledge and Skills test (TAKS). The obsession is related to school district funding, the no child left behind program and federal funding.

Dr. Cooper looked at the Math and Reading scores of 8189 5^th and 7^th graders and related it to the number of fitness standards achieved. Again the higher the fitness scores achieved the higher the math and reading scores on the TAKS test.

Miller in the Journal of Pediatric in 2006 looked at early onset of obesity and its effect on IQ and found;

“A link between marked obesity in toddlers and lower IQ scores, cognitive delay and brain lesions similar to those seen in Alzheimer’s disease was observed.” 

Dr. Cooper’s take home point is obesity is the villain and fitness is the cure. Texas schools eliminated Physical Education in order to have more resources to teach children to pass the achievement tests (TAKS). This seemed backwards to Dr. Cooper. He thought it might be better to promote fitness and decrease obesity. This would lead to an increase in test scores and a decrease in childhood type 2 diabetes mellitus.

Dr. Cooper then petitioned the Governor of Texas a Senator and State Representative to introduce a bill to reinstitute Physical Education in the Texas school systems on the basis of this information. The bill passed but was not funded.

Dr. Cooper raised 3 million dollars in private contributions for his Texas Youth Evaluation Project. He has to date tested over 1 million children. Fitness scores varied from 32 to 8/100 for girls depending on age and 27 to 8.5/100 for boys. The older the children the less fit they were.

His plan is to relate an increase in fitness to a decrease in obesity, and childhood type 2 diabetes mellitus. He is also going to study fitness and its relationship to attendance rates, free lunch programs, TAKS scores, substance abuse, violence and truancy.

My guess is that fitness will have the expected effect on all these parameters. The Youth Evaluation Program is now being spread to many school districts throughout the nation. The federal and state government must support programs to fight obesity. The obesity epidemic is devastating to individual citizens and our society.

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The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

Stanley Feld M.D.,FACP,MACE

Chronic Renal Disease (CKD) is another example of a disease that is asymptomatic until it reaches end stage renal disease. CKD is increasing with the rising incidence of obesity. Obesity causes patient to have a resistance to their own insulin. Insulin resistance is the hallmark of the Metabolic Syndrome and causes the onset of hypertension, hyperlipidemia (high cholesterol) and type 2 diabetes mellitus.

All of these chronic diseases along with aging are causing chronic kidney disease (CKD). At one time Dr. Norman Kaplan named this complex of diseases (obesity,hypertension,hyperlipidemia,and type 2 diabetes mellitus) the deadly quartet.

If obesity could be avoided or cured the cascade of these chronic diseases and their complications could be avoided. Since the treatment of the complications of chronic diseases result is 80% of the healthcare dollars spent, the total cost of healthcare would be drastically reduced.  

Many Americans are unaware that they are suffering from chronic kidney disease (CKD) because is often asymptomatic until its late stage. Inadequately treated hypertension can result in CKD. Many patients can not afford routine medical evaluations and do not discover hypertension until it is too late. Many patients can not afford medications prescribed so their adherence/ compliance with their physicians recommendations are less than 50%.

“An analysis of federal health data published last November in The Journal of the American Medical Association found that 13 percent of American adults — about 26 million people — have chronic kidney disease, up from 10 percent, or about 20 million people, a decade earlier”. “The burden on the health care system is enormous, and it’s going to get worse”.

“We won’t have enough units to dialyze these patients.”

It would be better to prevent CKD than to pay the cost for chronic dialysis or kidney transplantation. It can be done by preventing obesity along with early diagnosis and effective treatment of hypertension, hyperlipidemia and diabetes?

“Concerned about the emerging picture, federal health officials have started pilot programs to bolster public awareness, increase epidemiologic surveillance and expand efforts to screen those most at risk — people with high blood pressure, diabetes or a family history of kidney disease.”

Pilot programs take too long to complete. They are usually poorly designed to test the effectiveness of the program in the real world. If the concept is sound with minimum risk of failure it should be rolled out widely.

“Patients don’t understand that CKD encompasses a spectrum, and that the majority of patients are unaware they have the condition.” The path to kidney failure can take years.

“Only a tiny percentage of patients with kidney disease need dialysis,” Patients get dialysis or a kidney transplant only when they are in the final stage of the disease, also known as kidney failure or end-stage renal disease.

CKD progresses over the course of years, with its phases determined according to two criteria: the presence of protein in the urine, known as proteinuria, and how effectively the kidneys are processing waste products.

“ CKD itself can damage the cardiovascular system and lead to other serious medical conditions, like anemia, vitamin D deficiencies and bone disorders. Patients are far more likely to die from heart disease than to suffer kidney failure.”

The cost of dialysis should be zero in an ideal world with effective preventative medical care.

“In 2005, more than 485,000 people were living on dialysis or with a transplant, at a total cost of $32 billion. Medicare pays for much of that, because it provides coverage for patients needing dialysis or transplant even if they are not yet 65. In fact, kidney disease and kidney failure account for more than a quarter of Medicare’s annual expenditures.”

If obesity could be controlled and hypertension and diabetes secondary to obesity were eliminated at least another 24 billion dollars annually could be saved by our healthcare system.

The War on Obesity is vital to the survival of our healthcare system. CKD is just one more disease that is secondary to obesity. Our government must take the necessary role in influencing public opinion to reform our lifestyle to prevent the onset of obesity. Consumers must demand reform of the food industry and restaurant industry. The goal must be to a promote healthy lifestyle and discourage obesity.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.