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Childhood Obesity and Type 2 Diabetes

  • When diabetes hits home; the family as patient
  • Lifestyle vs. weight management
  • Targeting the family and lifestyle
  • The power of positive, empowered, holistic, interdisciplinary thinking
  • Theory and practice

Who you are must always be more important than how much you weigh…or if you have diabetes

What do adolescents and patients with type 2 diabetes have in common?
Both grow resistant to insulin


  • NIH: School based health promotion study (classroom curricula, food service modifications, Phys. Ed. Changes, and family reinforcement)
  • Reduce TV watching and video game playing


  • Restricting food causes children to eat more
  • Children who spend more time with TV, computers get less exercise and eat less healthy
  • "supersizing" meals the norm
  • no "clean plate club" when not hungry ..Aoops…High content fats and sugar (snack foods and take out) I.e. "junk foods" or "PC…. food of lower nutrient density

Focus choice not restriction

  • Relationship of restriction to binge eating
  • With restriction..Children worry, beg others, hide food, eat others leftovers
  • Nondiet approach


  • Physiology: we are hardwired to eat fats and carbohydrates (taste buds)
  • Socialization
  • Eating out of emotions


  • 20 minute rule: HALT (hungry, angry, lonely, tired
  • Managing feelings without food (journal for awareness; forming new habits)
  • Challenging sensory memory: neg and pos
  • Make motivation for self not parents, doctor
  • New habits: If you always do what you always did, you will always get what you always got



Improved eating,bs,and physical goals…NOT WEIGHT LOSS

  • Accept your innate biology
  • Eat 5 food groups (choc, cake, ice cream candy..)
  • Thin people not better..Make comparisons not judgments
  • Find normal body hunger as basic drive
  • Physically fit overweight are healthier than thin not fit…


  • Become aware of patterns: eating, activity, parenting, and family history of overweight (aunts, uncles) through monitoring
  • Family’s perception of problem and readiness to change; involve all family and extended family
  • Consider exogenous (depression, anxiety, abuse)
  • Check school performance, body image, social interaction


  • monitor
  • Identify barriers
  • Set goals..small (2 or 3-cut high sugar beverage)
  • Family problem solving skills
  • Communication skills around monitoring, medication adherence, discussion and negotiation of barriers
  • Regular visits for assessment and motivation

Food and activity intake records

  • Do you eat enough!!! Of foods your body needs? Fruit, grain vegetables (Ikeda and Kater); not talk about sugars, fats first
  • First eat more of what you should
  • Believe experiences of children not eating much (need fewer calories to maintain weight)
  • Portion sizes, liked and dislike foods, timing, social setting, family patterns and knowledge
  • Past history of intervention
  • TV, video habits, and activity awareness


  • Aerobic exercise 20-30 minutes daily
  • Family
  • Regular timing
  • Condition slowly
  • Park, community center, trainers, classes (karate, tae kwon do, soccer)


  • Eating habits, attitudes to self and children. Beliefs about change and food
  • Be aware of excessive control over food intake (choice not restriction)
  • Model behavior
  • Sensitive to limiting access to food (increases appeal and consumption)
  • Behavior mod: don’t eat standing up or in TV room, eat together, keep healthy snacks ready, portion control

Motivation maintenance

  • See patient regularly
  • Family system; friend system
  • "Walk the walk"; sessions while walking
  • Set up competition-collaboration with matching patient
  • Rule out depression and anxiety and need for medication
  • Change association of diabetes with loss and deprivation to health (consider Atkins? "Kids food")
  • After school exercise or team with parent
  • Self-management skills


  • Therapists: you don’t have to be crazy to see a therapist
  • Children are free when accompanied by adult at weight watchers
  • Consider hypnosis, relaxation training

Preventing burnout

  • Use referrals for provider and patient
  • Support systems: groups, team approach, family members, friends
  • Buddy systems (ww adopt a kid, mutual motivation)
  • Resiliency: There is only feedback not failure
  • Changing internal dialogue
  • Create more positive interactions
  • Non- diet approach: awareness and choice
  • Follow-up: phone calls and letters

Patient and provider
Internal dialogue and communication skills

  • I hate the diet
  • She always watches me
  • Kids tease me
  • I can’t do this
  • Parents and siblings: why do I have to suffer too
  • Provider: Your patient gained 5 lbs…

Coping for parents

  • Playful problem solving
  • Seeking social support
  • Positive reappraisal (I know how to be more helpful now)
  • Distancing by fathers (include them)
  • Inhibition of coping strategies with boy vs. girl

It takes a village…

  • We all own the problem of children not having healthy lifestyles
  • Lobby vending machines in schools, TV ads, public outcry
  • Spread the word that people come in all shapes and sizes
  • As professionals do not deliver guilt or punitive messages to parents or patients
  • Initial goal? slow down weight gain
  • Promote body satisfaction, self-esteem, and positive body image

Professional awareness

  • Impact on social and emotional well-being and not just the physical
  • Remember knowledge does not change behavior
  • Remember that all children struggle with sedentary lifestyle and poor food choices
  • Think lifestyle not obsession
  • Consider feast –famine cycle of poverty level (less money leads to higher fat foods. time of month.)

How to get your kids and families MOVING…

  • Set specific exercise goals (who, what, when, where, how)
  • Begin slowly and live with fatigue
  • Create a regular time slot
  • 15 minute rule: get started for only 15…
  • Have back-up plan
  • Make it fun, have right clothes-shoes-equip


I can’t do karate; I have no time and I'm too tired.
I can go to karate. I will get in shape. I can schedule time to go and accept my slow progress.

Understand lapse, relapse, and collapse

  • And plan accordingly…anticipation

USE OF HUMOR in diabetes and children

  • Discharge of negative emotions (Freud: a pleasurable discharge of negative emotions.)
  • Ability to talk about difficult situations
  • Provides new perspective
  • Social lubricant
  • Physical, immune system advantages (optimism and perceived control
  • Combat feelings of inferiority and vulnerability
  • Release stress in acceptable way (Q."Can you eat that? A.Why, is the cook that bad?)


  • Humor can be learned (Read a joke book, see a funny movie, watch comedians and children..)
  • Focus on looking for the odd side of a situation
  • Think about "telling" the story later as stress is happening
  • Better to "think funny" than to be funny
  • Use and model humor to patients
  • "Now take my diabetes...please."

Brownell’s learn program

  • Lifestyle
  • Exercise
  • Attitude and affect
  • nutrition




  1. "It’s your life."
  2. "Explain to me why you don’t feel like eating."
  3. "I’ll make you anything you want; steak, eggs? Or we can go out if you like. "
  4. "I’m going to get your father."
  5. Other

Your child refuses to eat. You say:


  1. "It’s your life."
  2. "Explain to me why you don’t feel like eating."
  3. "I’ll make you anything you want; steak, eggs? Or we can go out if you like. "
  4. "I’m going to get your father."
  5. Other

Sibling without Diabetes

You see your brother who has diabetes eating a candy bar after school with his friends.


  1. Immediately tell your parents; you can’t stand the guilt
  2. Immediately tell your patents; let him get in trouble - he gets too much attention, anyway.
  3. Share this with your brother & discuss with him how it makes you feel
  4. Go up to him and grab it out of his hands
  5. Other


The Patient says: "I refuse to test my blood sugars. I feel fine." You say:

  1. "It’s your life. I give up."
  2. "This is not a suggestion."
  3. "It sounds like you feel you have good reason not to test."
  4. "I’m so glad you trusted me enough to challenge me. I’m very interested in understanding why you are hesitating."

Motivation maintenance

  • See patient regularly
  • Family system
  • Mentor
  • Competition (big sister)
  • Peer counselor
  • Change!


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