Category Archives: Diabetes

Extreme obesity may shorten life expectancy up to 14 years

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ScaleFrom the National Cancer Institute

Adults with extreme obesity have increased risks of dying at a younger age from cancer and many other causes including heart disease, stroke, diabetes, and kidney and liver diseases, according to a new study.

The study, led by researchers from the National Cancer Institute (NCI), part of the National Institutes of Health, found that people with class III (or extreme) obesity had a dramatic reduction in life expectancy compared with people of normal weight. The findings appeared July 8, 2014, in PLOS Medicine.

 Six percent of US adults are now classified as extremely obese

“While once a relatively uncommon condition, the prevalence of class III, or extreme, obesity is on the rise. In the United States, for example, six percent of adults are now classified as extremely obese, which, for a person of average height, is more than 100 pounds over the recommended range for normal weight,” said Cari Kitahara, Ph.D., Division of Cancer Epidemiology and Genetics, NCI, and lead author of the study.  Continue reading

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Bionic pancreas outperforms insulin pump in adults, youth – NIH

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Diabetes pump

From right, researcher Dr. Steven Russell of Massachusetts General Hospital stands with Frank Spesia and Colby Clarizia, two participants in a type 1 diabetes trial testing an electronic device called a bionic pancreas – the cellphone-sized device shown – which replaces their traditional fingerstick tests and manual insulin pumps. Photo courtesy of Adam Brown,

From the National Institutes of Health

People with type 1 diabetes who used a bionic pancreas instead of manually monitoring glucose using fingerstick tests and delivering insulin using a pump were more likely to have blood glucose levels consistently within the normal range, with fewer dangerous lows or highs.

The report was published online by the New England Journal of Medicine

TThe researchers — at Boston University and Massachusetts General Hospital — say the process of blood glucose control could improve dramatically with the bionic pancreas. Currently, people with type 1 diabetes walk an endless tightrope.

Because their pancreas doesn’t make the hormone insulin, their blood glucose levels can veer dangerously high and low.

Several times a day they must use fingerstick tests to monitor their blood glucose levels and manually take insulin by injection or from a pump.

In two scenarios, the researchers tested a bihormonal bionic pancreas, which uses a removable tiny sensor located in a thin needle inserted under the skin that automatically monitors real time glucose levels in tissue fluid and provides insulin and its counteracting hormone, glucagon, via two automatic pumps. Continue reading

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Are you the 1 in 4 who doesn’t know? – CDC asks

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Question MarkMore than 29 million people in the United States have diabetes, up from the previous estimate of 26 million in 2010, according to a report released today by the Centers for Disease Control and Prevention.

One in four people with diabetes doesn’t know he or she has it. 

Another 86 million adults – more than one in three U.S. adults – have prediabetes, where their blood sugar levels are higher than normal but not high enough to be classified as type 2 diabetes. Continue reading

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All about sugar substitutes

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fda-logo-thumbnailAn FDA Consumer Update

Whether it’s to cut down on the number of calories they consume or any of a variety of other reasons, some people use sugar substitutes – also called high-intensity sweeteners – to sweeten and add flavor to their foods.

They can be used alone to sweeten foods and beverages such as iced tea or coffee, or as an ingredient in other products. There are a number of sugar substitutes on the market from which to choose. Continue reading

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Obese employees cost employers thousands in extra medical costs – study

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ScaleBy Katherine Kahn
Health Behavior News Service

A new study in the American Journal of Health Promotion finds that, on average, a morbidly obese employee costs an employer over $4,000 more per year in health care and related costs than an employee who is of normal weight.

The study also revealed that obese individuals who had comorbidities such as high blood pressure, diabetes, and high cholesterol incurred more costs than obese workers without these conditions, says Karen Van Nuys, Ph.D., lead coauthor and economist at Precision Health Economics in Los Angeles.

“For example, someone who is overweight or obese and also has diabetes is more likely to file a short-term disability claim compared to someone who doesn’t have diabetes but is overweight or obese.” Continue reading

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Patient education tops physician training for diabetes control – study

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Glucometer showing a blood sugar of 105People with diabetes who received counseling at clinic appointments had a 49 percent greater likelihood of achieving long term blood glucose control than patients that did not receive counseling. 

Physician training about managing diabetes seemed to be ineffective at helping patients control their glucose levels, whether or not patients received counseling.

By Valerie DeBenedette
Health Behavior News Service

Teaching people with diabetes how to control their blood glucose levels helps them achieve better results, finds a new study in Ethnicity and Disease.

Surprisingly, providing intensive training to physicians of diabetes patients did not help patients achieve blood glucose control. Continue reading

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FDA warns consumers to stop using GenStrip Blood Glucose Test Strips.

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GenStrips

From the FDA

The US Food and Drug Administration is advising people with diabetes and health care professionals to stop using GenStrip Blood Glucose Test Strips because the strips may report incorrect blood glucose levels.

GenStrip Blood Glucose Test Strips, sold by Shasta Technologies LLC, are “third-party” blood glucose monitoring test strips. Shasta’s GenStrips are advertised for use with the LifeScan OneTouch family of glucose meters (e.g. Ultra, Ultra 2 and Ultra Mini). Continue reading

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Women’s Health – Week 34: Obesity

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From the Office of Research on Women’s Health

tacuin women

Obesity is about more than just your looks. Today, two out of three adults in the United States are considered overweight or obese.

Obesity puts people at increased risk for chronic diseases, such as heart disease,  type 2 diabetes,  high blood pressure,  stroke,  and some forms of cancer. Continue reading

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Women’s Health – Week 18: Gestational Diabetes

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From the Office of Research on Women’s Health

Gestational diabetes (pregnancy)

Gestational diabetes is diabetes that occurs when a woman is pregnant. Changing hormone levels and weight gain are all part of a healthy pregnancy.

But both these changes can make it hard for your body to keep up with its need for a hormone called insulin. Your body may not get the energy it needs from the food you eat and, later in your pregnancy, you could develop gestational diabetes.

Gestational diabetes often goes away after the baby is born but having gestational diabetes can place you and your child at increased risk for developing diabetes later in life.

Taking care of yourself will help keep you and your baby healthy throughout your lives. Important action steps include:

  • Reaching and maintaining a healthy weight.
  • Being physically active for 30 minutes at least 5 days a week.
  • Following a healthy eating plan.

Your health care provider will decide when you need to be checked for diabetes depending on yourrisk factors. Risk factors include:

  • Age: 25 years of age or older.
  • Weight: Being overweight or obese.
  • Family history: Having a parent, brother, or sister with diabetes.
  • Baby’s birth weight: Delivering a baby weighing more than 9 pounds.
  • Health history: A previous diagnosis of gestational diabetes in an earlier pregnancy.
  • Blood glucose (blood sugar): Having pre-diabetes, a condition in which blood glucose levels are higher than normal.
  • Race/ethnicity: Being of African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander descent.
Risks of gestational diabetes
Having gestational diabetes may increase your risk of high blood pressure or your baby may grow very large. Both can make delivery difficult and dangerous for you both. It can also cause other problems for your baby including: 

  • Low blood glucose right after birth.
  • Breathing problems.
NIH and You
The NIH Office of Research of Women’s Health has partnered with the National Institute of Diabetes and Digestive and Kidney Disease’s National Diabetes Education Program on its Small Steps. Big Rewards – It’s Never Too Early…To Prevent Diabetes campaign to increase awareness about the future health risks for women with a history of gestational diabetes and their children. The campaign promotes screening for type 2 diabetes in women with a history of gestational diabetes, provides advice on future health risks, and promotes the importance of adopting and maintaining healthy behaviors.

for more information: www.niddk.nih.gov

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Women’s Health – Week 17: Complications of Diabetes

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From the Office of Research on Women’s Health

Complications of diabetes

If you have diabetes, you may be at greater risk for many serious health problems. But if you follow your treatment plan and make lifestyle changes, you may be able to prevent or delay serious health problems. Some common complications of diabetes are below.

Eye disease

Damage to the eyes can lead to severe vision loss or even blindness. Eye problems may include:

  • Retinopathy: damage to the blood vessels in the retina. Diabetic retinopathy gets worse with time. You may not notice vision changes at first. Timely treatment and follow-up care help prevent serious vision loss. Diabetic retinopathy usually affects both eyes and is a leading cause of blindness in adults.
  • Cataract: clouding of the eye’s lens. Cataracts develop at an earlier age in people with diabetes.
  • Glaucoma: increase in fluid pressure inside the eye, which leads to optic nerve damage and loss of vision. A person with diabetes is nearly twice as likely to get glaucoma as other adults.

Kidney failure

Diabetes is the most common cause of chronic kidney disease (CKD) and kidney failure, though most people with diabetes do not develop CKD that is severe enough to progress to kidney failure.

People with kidney failure undergo dialysis, an artificial blood-cleaning process, ortransplantation to receive a healthy kidney from a donor.

Researchers have found that high blood pressure and high levels of blood sugar increase the risk that a person with diabetes will develop kidney failure. Controlling your blood pressure and blood sugar may reduce your risk.

Nerve disease

Diabetes can cause serious nerve problems, or neuropathies. People with diabetes can develop nerve damage throughout their body. Some people with nerve damage have no symptoms. Others may experience pain, tingling, or numbness – loss of feeling – in the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs. People with diabetes can develop nerve problems at any time, but risk rises with age and the longer a person has diabetes. Neuropathies also appear to be more common in people who have problems controlling their blood sugar as well as those who are overweight or who have high blood pressure or high levels of blood fat.

Foot ulcers and amputations

People with diabetes need to take special care of their feet. The nerves to the feet, the longest in the body, are most often affected in diabetes. Loss of sensation in the feet means that sores or injuries may go unnoticed and may become ulcerated or infected.

Circulation problems also increase the risk of foot ulcers. More than half of all lower-limb amputations in the United States occur in people with diabetes – 86,000 amputations per year.

Health care providers estimate that nearly half of the amputations caused by neuropathy and poor circulation could have been prevented by careful foot care.

Periodontal disease

People with diabetes are at higher risk for developing infections, including periodontal, or gum disease. For more information on dental health, please see Week 13.

For more information: www.ndep.nih.gov

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Women’s Health – Week 16: Diabetes: Type 1 and Type 2

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From the Office of Research on Women’s Health

Glucometer showing a blood sugar of 105Diabetes is a disease in which your blood glucose, or sugar, levels are too high. Glucose comes from the foods you eat. Your blood always has some glucose in it because your body needs glucose for energy. Too much glucose, however, is not good for your health.

Insulin, a hormone produced by the pancreas, helps the glucose from food get into your cells. If your body does not make enough insulin, or if the insulin does not work the way it should, glucose cannot get into your cells for energy. It stays in your blood instead. Your blood glucose levels then get too high, causing diabetes.

With type 1 diabetes, the pancreas no longer makes insulin. People with type 1 diabetes need to take insulin every day. Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States. Children and young adults most often develop type 1 diabetes, but it can appear at any age.

With type 2 diabetes, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood. People with type 2 diabetes often need to take pills or insulin. Type 2 diabetes is the most common form of diabetes and can occur at any age, even childhood.

Having a parent, brother, or sister with diabetes, or being overweight and inactive increases the chances of developing type 2 diabetes.

Pregnant women can also develop diabetes, called gestational diabetes (see Week 18 for more information). Gestational diabetes often goes away after the baby is born. But having gestational diabetes can place you and your child at increased risk for developing diabetes later in life.

Symptoms of diabetes may include fatigue, thirst, weight loss, blurred vision, and frequent urination. With type 2 diabetes, some people have no symptoms at all. A blood test can show if you have diabetes.

Over time, having too much glucose in your blood can cause serious problems. It can damage your eyes, kidneys, heart, gums, teeth, and nerves. It can lead to blindness, kidney failure, and the loss of a foot or a leg. The most serious problem caused by diabetes is heart disease. If you have diabetes you are more than twice as likely as people without diabetes to have a heart attack or a stroke.

The good news is that if you have diabetes, you can take steps to manage the disease. Learn how to manage the ABCs of diabetes. A is for the HbA1C test, which shows you what your blood glucose has been over the past 3 months. B is for blood pressure and C is for cholesterol.

You can lower your chances of developing serious health problems by keeping your blood glucose, blood pressure, and cholesterol levels in the target range your health care provider gives you. You can manage your diabetes by being active every day and keeping your weight in a healthy range. Follow your meal plan, take your medications, and check your blood glucose as directed by your health care provider.

For more information: www.yourdiabetesinfo.org

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Eye exam

This National Diabetes Month: remember to keep an eye on your eyes

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From the National Institutes of Health

If you are one of more than 25 million Americans with diabetes, you may already know the importance of watching your diet and keeping track of your blood sugar. But did you know it’s also important to have regular eye exams?

In the United States, diabetic eye disease is the leading cause of vision loss among working-age adults. Diabetic retinopathy is the most common form of this disease, and affects about 28.5 percent of Americans with diabetes age 40 and older. That’s more than 7 million people, and the number is expected to reach more than 11 million by the year 2030.

The condition can creep up quietly. It gradually weakens small blood vessels in and around the retina, the light-sensing layer of tissue at the back of the eye. If the disease progresses, these vessels may rupture and leak blood into the eye; they can also spread and grow on the surface of the retina and cause scarring.

Typically, diabetic retinopathy has no symptoms until it reaches an advanced stage. But the disease can be detected early through a comprehensive dilated eye exam. In this procedure, an eye professional will put drops in your eye to dilate (widen) the pupil, which allows a closer look at the retina.

The good news is that with early detection, timely treatment, and appropriate follow-up, the risk of severe vision loss from diabetic retinopathy can be reduced by 95 percent.

There are several effective treatment options including laser surgery and injections of anti-VEGF drugs. These drugs block the actions of a protein that can cause abnormal blood vessels to grow and leak fluid.

 

A comprehensive dilated eye exam can catch diabetic eye disease early, before symptoms appear.

November is National Diabetes Month. If you have diabetes, it’s a good time to remember these health tips:

  • Get a comprehensive dilated eye exam at least once a year.
  • Control your blood sugar, blood pressure and cholesterol levels. By controlling your diabetes, you’ll reduce your risk of diabetic eye disease.
  • Talk to your eye care professional about diabetic retinopathy.
  • Learn more about diabetic eye disease from the National Eye Institute, part of the National Institutes of Health.

NEI’s Diabetic Retinopathy Clinical Research Network (DRCR.net) conducts large multi-center trials of new therapies for diabetic eye disease; it comprises nearly 1000 investigators at sites in 48 states.

Many of the sites are private practice eye clinics, enabling the network to quickly bring innovative treatments from research into community practice. An ongoing trial is comparing three anti-VEGF drugs for macular edema, a complication of diabetic retinopathy that causes central vision loss. For more information, please see trial NCT01627249 at http://www.clinicaltrials.gov.

The National Eye Institute, part of the National Institutes of Health, leads the federal government’s research on the visual system and eye diseases. NEI supports basic and clinical science programs that result in the development of sight-saving treatments. For more information, visit http://www.nei.nih.gov.

About the National Institutes of Health (NIH): 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. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

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Understanding obesity in children – AHRQ summary for parents

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Kids 1From the US Agency for Healthcare Research and Quality

How do I know if my child is at a healthy weight?

young boy on scaleYour child’s doctor will track your child’s height and weight over time and can tell you if your child is at a healthy weight. During wellness checkups, be sure to talk with your child’s doctor about your child’s weight.

Your child’s doctor may ask you about:

  • Your child’s eating habits
  • Whether you have places to get healthy food for your child
  • How much physical activity your child gets
  • Whether there are safe places for your child to run around and play
  • How much screen time your child has each day (time spent watching television, playing video games, or sitting in front of a computer, cell phone, or tablet such as an iPad)
  • Any health problems your child has
  • Your family’s medical history

What is BMI and what are BMI percentiles?

To find out if your child is in a healthy weight range, your child’s doctor may use something called BMI, or “body mass index.” BMI is a measurement based on your child’s height and weight. BMI helps the doctor estimate how much body fat your child has. The doctor can use BMI to see if your child is at a healthy weight for his or her height. A healthy BMI is different for girls and boys and changes by age.

Your doctor may compare your child’s BMI to the typical BMI range for children of the same sex and age. To do so, doctors may use what is called a “BMI percentile.” This can help the doctor figure out if a child is underweight, at a healthy weight, overweight, or obese.

According to the Centers for Disease Control and Prevention (CDC), children are considered:

  • At a healthy weight if their BMI is between the 5th and 85th percentile
  • Overweight if their BMI is between the 85th and 95th percentile
  • Obese if their BMI is in the 95th percentile or above

To calculate your child’s BMI and BMI percentile, go to http://apps.nccd.cdc.gov/dnpabmi/.

What health problems can being overweight or obese cause for a child?

Children who are overweight or obese are more likely to be overweight or obese as adults. They are also more likely to develop serious health problems such as:

  • High blood sugar or diabetes
  • High blood pressure
  • High cholesterol (a type of fat in the blood)
  • Sleep apnea (a condition in which you stop breathing for brief periods of time while you sleep)
  • Heart problems (such as heart attack or heart failure) or a stroke as an adult
  • Extra pressure on bones and joints, which could lead to bone and joint problems both as a child and as an adult
  • Nonalcoholic fatty liver disease (a disease caused by too much fat in the liver)
  • Low self-esteem or depression
  • Eating disorders such as binge eating and purging

What might lead to a child becoming overweight or obese?

Many things can lead to a child becoming overweight or obese, including:

  • Unhealthy eating habits. Children may eat too much, eat too many unhealthy foods, or drink too many sugary drinks.
  • Not getting enough sleep. Children who do not get enough sleep each night are more likely to become overweight.
  • Family history. Children from overweight families may be more likely to become overweight. This could be due to a child’s genes or learned family eating habits.
  • Not enough physical activity. Children may not get enough physical activity. Children should be active for at least 1 hour each day.
  • Too much screen time. Children may have too much screen time during the day. Some children may eat while watching television or playing on the computer.
  • Environment. Children may spend time in an environment (such as with relatives, with friends, in childcare, or at school) where healthy eating choices or opportunities for physical activity are not available.Keeping Your Child From Becoming Overweight or Obese

How can I keep my child from becoming overweight or obese?

To help keep your child from becoming overweight or obese, make sure your child eats healthy and is physically active. There are many things that can be done at home, in school, and in the community to help keep children at a healthy weight. Some examples of each are listed below.

At Home

There are many things you can do at home as a family. Some examples include:

Eat healthy
  • Cook healthy meals at home with foods from each food group.
    • The food groups include fruits, vegetables, grains, protein foods (such as meats, eggs, fish, tofu, and beans), and low-fat or nonfat dairy.
  • Be sure to eat a healthy breakfast every day.
  • Eat at the table as a family instead of in front of a screen (television, computer, cell phone, or tablet).
  • Limit or do not keep unhealthy foods and drinks at home.
    • Replace unhealthy snacks such as cookies, candy, or chips with healthy snacks such as fruits and vegetables.
    • Replace unhealthy sugary drinks such as sodas, sports drinks, or juices with healthy drinks such as water and low-fat or nonfat milk.
  • Eat most meals at home instead of at restaurants. At home, you are better able to limit the amount of fat, sugar, and salt in your meals.
  • Be sure to eat the right amount of food.
For more information about healthy foods, eating the right amount, and sample menus, go to http://choosemyplate.gov.
father swimming with his childrenBe physically active
  • Give your child a chance to run around and play – at least 1 hour a day.
  • Plan fun activities like bicycling, walking to the park, playing ball, or swimming.
  • Encourage everyone in the family to be active during the day.
    • For example, take the stairs instead of the elevator and walk or bike places instead of driving or taking the bus.
  • Limit the amount of screen time each day.
  • In addition to being physically active, make sure your child gets enough sleep each night.

Let’s Go! is a program to keep children from becoming obese. The program focuses on healthy eating and physical activity.

Let’s Go! recommends the “5-2-1-0” healthy habits for each day:

  • 5 fruits and vegetables
  • 2 hours or less of screen time for recreation
  • 1 hour or more of physical activity
  • 0 sugary drinks

Let’s Go! also recommends keeping television and computers out of your child’s bedroom and not allowing screen time for children younger than 2 years.

Let’s Go! is a State of Maine program that also supplies resources to communities outside of the State. These graphics and messages are adapted from Let’s Go! at www.letsgo.orgExit Disclaimer

In School

Girl in cafeteria line

In addition to eating healthy and being physically active at home, school programs can help keep children at a healthy weight. School programs could include things such as:

  • Lessons about the importance of healthy eating and physical activity
  • Information sessions for parents to learn ways to help keep their child at a healthy weight
  • Healthy breakfast and lunch options in the cafeteria with the right portion sizes
  • Healthy snacks and drinks in vending machines and at parties and events
  • Filtered water coolers to encourage drinking water instead of soft drinks or sports drinks
  • Adult-led walk-to-school or bike-to-school groups
  • A longer physical education (PE) period in which children are physically active
  • Gym equipment such as balls and jump ropes for use during recess

Let’s Go! also has resources for schools to help children eat healthy and be physically active. For more information and toolkits for your child’s school, go to www.letsgo.org/toolkits/Exit Disclaimer

To find out what your child’s school is doing to help keep children from becoming overweight or obese, talk with your child’s principal, school nurse, or school counselor. You can also ask how to become involved in the school’s Parent-Teacher Association (PTA) or Parent-Teacher Organization (PTO).

In the Community

In addition to home and school, things can also be done in the community to help keep children at a healthy weight. Communities and community centers can:

  • Improve community parks, sidewalks, and biking paths.
  • Take steps to make parks, sidewalks, and biking paths safe.
  • Advertise community events such as health fairs, 5K walks, sports events at local parks, community garden programs, and local farmers markets. This can be done on posters, in local newspapers, and on local television and radio stations.
  • Offer programs in which families can get advice on healthy eating and being physically active.

For other resources to help keep your child at a healthy weight, go to:

For more information about improving parks, sidewalks, and biking paths in your area, contact your local parks and recreation department.

For more information about events or programs in your community, contact your local community or recreation centers (such as the YMCA, Boys and Girls Club, or local religious community centers).

What have researchers found about doing things at home, in school, and in the community to help keep children from becoming overweight or obese?

Healthy eating and physical activity are very important in keeping children from becoming overweight or obese.

Researchers found that:

  • Programs at schools to help children eat healthy and be physically active can keep children from becoming overweight or obese.
  • Along with school programs, additional steps at home and in the community can also help.
  • More research is needed to know which particular programs or steps work the best.
  • Talking With Your Child’s Doctor, School, and Community Centers

Examples of Questions To Ask Your Child’s Doctor

  • Is my child at a healthy weight?
  • What are the most important things for me to do at home to help keep my child at a healthy weight?
  • How can I get my child to eat healthy foods?
  • How much of each type of food should my child eat?
  • How much physical activity does my child need each day?
  • What are the best types of physical activity for my child?
  • How much screen time should I allow my child each day?
  • How much sleep should my child get each night?
  • Do you have any resources that can help me keep my child at a healthy weight?
  • Do you know of any community resources that can help?
  • If there are no grocery stores nearby or healthy food is too expensive for me, do you know of any resources that could help me?
  • If there is no safe place for my child to play outside, how can I help my child stay active?

Examples of Questions To Ask Your Child’s School Principal, Nurse, or Counselor

  • Does the school offer programs to help keep children from becoming overweight or obese? If not, how can we start some?
  • In the cafeteria and in vending machines, are healthy foods such as fruits and vegetables available instead of sugary drinks and salty or fatty foods?
  • How much time is my child given during PE, recess, and throughout the day to be physically active?
  • Does the school ever use PE or other physical activity as punishment?
  • Do you have adult-led walk-to-school or bike-to-school programs or other physical activity programs for children?
  • Are there information sessions that I can attend to learn more about helping my child stay at a healthy weight?
  • What can I do at home to help reinforce what my child is taught about healthy eating and physical activity at school?
  • Do you know of any community resources that can help?

Examples of Questions To Ask Your Local Community or Recreation Center

  • Do you have any resources or programs on healthy eating or physical activities for children?
  • Do you keep a calendar of community events such as health fairs, 5K walks, or sports events at local parks?
  • Do you have a list of local community gardens or farmer’s markets?
  • Do you know of any programs that can give me advice on how to help my family eat healthy and be physically active?Sources

The information in this summary comes from the report Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis, June 2013. The report was produced by the Johns Hopkins University Evidence-based Practice Center through funding by the Agency for Healthcare Research and Quality (AHRQ).

Additional information came from the MedlinePlus® Web site, a service of the National Library of Medicine and the National Institutes of Health. The site is available at www.nlm.nih.gov/medlineplus.

This summary was prepared by the John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine, Houston, TX. It was written by Amelia Williamson Smith, M.S., Jason A. Mendoza, M.D., M.P.H., and Michael Fordis, M.D. Parents of children between the ages of 2 and 18 reviewed this summary.

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