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A Big Fat Problem
What are the Costs of Obesity?

by Jeff Worley

Remember the fattest kid in fourth grade? The one who was the butt of practical jokes and the target of ugly nicknames? The one always picked last on the playground? Obesity, clearly, can be a boulder in the road to a child's socialization and self-esteem. The slings and arrows of words directed toward an overweight kid can leave permanent psychological scars.

It wouldn't be such a big deal if the problem were only a kid's confidence or looks. But there's a lot more to it than that. According to the CDC, our nation spent an estimated $75 billion last year treating health problems of children and adults related to obesity. In 2003, 6.2 percent of all Kentucky's medical expenses went to treating obesity-related health problems. As reported in the Lexington Herald-Leader, Medicare picked up about $270 million of that tab, and Medicaid, which serves the poor, shelled out another $340 million. This works out to a cost of about $85 for every man, woman and child in our state.

And as we've known now for a long time, obesity is a fertile breeding ground for chronic diseases like type 2 diabetes, cardiovascular disease and arthritis. It is causally connected to cancers including endometrial cancer, some breast cancers, colon and kidney cancer; and obesity also instigates sleep apnea, gall bladder disease, back and joint disorders, and depression.

"And this is just the short list for where obesity can lead," says Anderson, who thinks that in his work with overweight children and teens, diabetes is the most important concern. "We used to see very few children or teens with type 2 diabetes, but now it's alarming how many adolescents are developing type 2." The obesity-diabetes link is so strong that his colleague L. Raymond Reynolds, an associate professor of internal medicine at UK, often uses the term "diabesity" to convey how interrelated they are.

Type 2 diabetes results from insulin resistance, a condition in which the body fails to use insulin properly, combined with relative insulin deficiency. (Type 1 diabetes results from the body's failure to produce insulin, the hormone that unlocks the cells of the body, allowing glucose to enter and fuel them.) Most Americans diagnosed with diabetes have type 2. Get this: Prior to 1990, of all cases of diabetes in children, just 4 percent were type 2; now, type 2 diabetes in children and adolescents accounts for a whopping 45 percent of cases, according to the American Diabetes Association.

Leslie Scott, a pediatric nurse at the University of Kentucky Medical Center who earned a Ph.D. in nursing from UK earlier this year, is an expert on type 2 diabetes in children. "I've always loved working with kids," says Scott, who has been a clinical pediatrics faculty member here since 1998. "When I became a nurse practitioner in 1995, the children we followed in the pediatric endocrine clinic primarily had type 1 diabetes. But even then we were seeing significant increases, almost year-to-year, in the number of children with type 2 diabetes."

Scott, who became a pediatric diabetes nurse educator in 1994, was inspired to dedicate herself to a career of diabetes-related work for a reason very close to home. Her mother had diabetes from the age of 10 and lost her sight at 32 as a complication of the disease. Scott, in living with her mother's disease and being in regular contact with diabetes educators through the years, learned that education really can make an impact on how people manage the disease.

"I wanted to try to prevent kids from suffering complications like my mother did at such a young age. I thought that if we could affect a family at that level, at a young age, and implement good habits and good management skills, we could prevent complications down the road."

Preventing health problems. This is the goal of dozens of clinicians and researchers at UK working to better understand childhood and adolescent obesity. This work involves disciplines, departments and colleges all across the UK campus. Here are a few of the projects and programs currently under way.

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