“We eat morning, noon and night, but we were not taught how to eat healthfully. We learn how to read and write, but not how to eat.” Joel Robuchon
The International Diabetes Federation (IDF) released their most recent projections – by 2030, one in ten adults will have diabetes. Given the three-fold increase in obesity prevalence among children and adolescents over the past few decades (1), one can only hope this is not an underestimation.
The Canadian Community Health Survey (CCHS) results indicate that 25% of Canadian children are overweight or obese (2). It is no great secret why rates of diabetes are climbing – inactivity and energy-dense, nutrient-poor diets are contributing to excess weight, the number one risk factor for type 2 diabetes.
According to the Canadian Health Measures Survey (CHMS), fitness levels of Canadian children and youth declined significantly between 1981 and 2009, mirroring levels in adults, particularly those 20 – 39 years of age (3). Not surprisingly, the percentage of 15 – 19 years olds with a high-risk waist circumference (> 90th age and gender percentile) more than tripled. In the young adult range (20 – 39 years), high-risk waist circumferences quadrupled – from 5% to 21% among men (>102 cm), and from 6% to 31% among women (> 88 cm) (3).
The CCHS reported that approximately 25% of total caloric intake among Canadians aged 14 – 30 years came from “other foods” category, with soft drinks accounting for the greatest proportion (11.3%) of “other” calories. These young adults also have the highest reported fast food consumption rates of any age group (2). Not surprisingly, overall diet quality scores are also low in these age groups. When intakes from the CCHS were translated into a Healthy Eating Index score (composite measure of “adequacy” and moderation”, score range 0 – 100), approximately 25% of 14 – 30 year olds had scores of less than 50 (4).
This poor diet quality is of particular concern in relation to inadequate intakes of vegetables, fruit, whole grains and total fibre – it isn’t all about fat. In an NHANES data study, Carlson et al. (5) looked at the presence of Metabolic Syndrome (MetS diagnosis includes three or more of: high-risk waist circumference, insulin resistance, high blood pressure, low HDL, elevated triglycerides) and dietary intake among over two thousand 12 – 19 year olds. An alarming 6.4% of children met diagnostic criteria for MetS; another 21% had two risk factors and 42% had one risk factor. Interestingly, there was no relationship between MetS and saturated fat or cholesterol intake, yet there was a three-fold increase in the number of children that had MetS when the group of children receiving the lowest fibre (3 g fibre per 1000 kcal) was compared with the group receiving the most (11 g fibre per 1000 kcal).
What can be done? A recent meta-analyses of school-based obesity interventions found that the most successful programs were long-term (> 1 year), incorporated diet and physical activity, and had a strong family component (6). While these programs are being adopted in many schools, they can be expensive and do require parental or family commitment for success – no easy task and certainly not a fit for every demographic.
So, how do we then try to bridge the gap for the undetermined number of overweight/obese children who will become overweight/obese young adults? This is an entirely different demographic with very different needs… but do we know how to address them? In a pooled analysis (7), data suggests that current behavioural-based programs (which are frequently successful in adults) DO NOT meet the needs of young adults – recruitment is lower, attrition rates higher and less weight loss is sustained in those 18 – 35 years vs. older adults.
The International Diabetes Federation is calling for urgent and drastic action – but what? Is fat and sugar tax the answer? Getting family services involved? Banning junk food in schools? A complete government shift to more initially expensive, preventive upstream changes (we wish!)? Obviously the status quo will not be enough, so what would you suggest in a ideal (and hopefully pseudo-realistic) world?
We would love to hear your thoughts – leave them in the comments!
1. Lee JM. Why young adults hold the key to assessing the obesity epidemic in children. Arch Pediatr Adolesc Med 2008;162:682-7.
2. Statistics Canada. Canadian Community Health Survey; 2004
3. Statistics Canada. Canadian Health Measures Survey: 2007 – 2009. Released Jan 2010.
4. Garriguet D. Diet Quality in Canada. Statistics Canada, 2009.
5. Carlson JJ, Eisenmann JC, Norman GJ, Ortiz KA, Young PC. Dietary fiber and nutrient density are inversely associated with the Metabolic Syndrome in US adolescents. J Am Diet Assoc 2011; 111: 1688-95.
6. Khambalia AZ, Dickinson S, Hardy LL, Gill T, Baur LA. A synthesis of existing systematic reviews and meta-analyses of school-based behavioural interventions for controlling and preventing obesity. Obes Rev 2011 [epub ahead of print]
7. Gokee-LaRose J, Gorin AA, Raynor HA, Laska MN, Jeffery RW, Levy RL, Wing RR. Are standard behavioral weight loss programs effective for young adults? Int J Obes 2009; 33:1374–80.