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 8th 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 5th and 7th 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.
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.