有糖尿病和肥胖风险的小学生与健康的生活方式

hxq2007

健康生活方式从娃娃抓起
Children Can Be Taught About Healthy Lifestyles

Bob Roehr

February 26, 2008 (Austin, Texas) — Elementary school students at high risk for diabetes and obesity can be educated about healthier lifestyles, and that information can be retained for a least 9 months. These results came from Program ENERGY, presented here at Prevention Medicine 2008, the annual conference of the American College of Preventive Medicine.

The goal of the operational research has been \"to see if we can do some prevention by how we educate and teach science\" at the elementary school level, said program advocate Art Campfield, PhD. He is a food and nutrition researcher at Colorado State University, Fort Collins, who has made major contributions to understanding the role of leptin in metabolism.

\"What is very disturbing is that type 2 diabetes and obesity are largely preventable,\" he said. \"We need to communicate more clearly that lifestyle choices can prevent things like diabetes.\" Much of that comes down to imparting a better understanding of energy balances involved with eating and physical activity; \"Kids need to know how their bodies work so they can make appropriate health decisions.\"

Dr. Campfield said most diabetes prevention programs aimed at kids are missing \"any notion of energy balance, the science of the human body, blood glucose regulation, how you prevent [these diseases], and body image and self esteem.\"

He has focused on low-income elementary schools with large enrollments of Hispanic, Native American, or African-American students; a third to half of the students in these schools are overweight. He has worked for the last 7 years with schools in Colorado, Texas, and West Virginia.

The focus is hands-on learning activity in small groups, with 4 to 5 students total from the second, fourth, and sixth grades working with each volunteer — often a college student, although high school students, parents, and others have participated — in a 45- to 60-minute session every week or every other week. The volunteers are supervised by a mentor in the classroom. All activities are planned in collaboration with the teacher, who may or may not be present in the classroom, and the content is shuffled to complement other teaching activities.

The study was funded by the National Institutes of Health, and resources are freely available online at http://www.programenergy.org.

Dr. Campfield emphasized, \"One size does not fit all.\" The key to success is building a bottom-up collaboration with the teacher and adapting to the lesson plan of the individual classroom. \"Each class and educator forms a unique community that is different every year in every class.\"

Baseline testing found that up to half of the kids knew someone with diabetes, and about a third knew that healthy eating and exercise were important to preventing diabetes. However, very few knew that maintaining a healthy weight was also important.

Compared with matched control schools, the researchers found that the program roughly doubled knowledge of diabetes. Only 8% of the children had no increase in their knowledge score from baseline, whereas 92% did increase that knowledge score. Knowledge was sustained at 9 months after completion of the program. Outcomes were similar with interventions on weekly and every-other-week schedules.

The program \"has an apparent effect on body acceptance,\" Dr. Campfield said. \"By the end of the intervention, they are much more wiling to accept how they are.\"

Dr. Campfield's passion was clearly evident when he added, \"The debate about whether lifestyle [changes] can work is over. It's not time for more research, it's time to hit the pavement and teach the people of this country that a disease that can cost $10,000 more a year in healthcare can mostly be prevented.\"

One member of the audience suggested that a change in body mass index (BMI) would be an important measure of success. \"But however effective your program may be, given the magnitude and complexity of the problem, by itself it likely is not going to be enough.\"

Dr. Campfield acknowledged that. He said they stratified the children into obese, overweight, and healthy weight groups and have seen little overall change in gross BMI in those who went through the program in the sixth grade and who have been followed over time. Those who are obese or healthy tend to stay there, and there is a trend for those who are overweight to become healthy. He said, \"We are trying to build up a large enough N to make the case that this is a successful prevention.\"

He believes that too much emphasis is placed on BMI alone and argued that one also should look at other factors such as improved health and quality of life.

When pressed on how to expand and institutionalize such a program, Dr. Campfield said, \"The key issue is to show interest in the child.... It was special because the [college] students came and cared — it is nothing about a particular fact of science.\"

He told Medscape Public Health & Prevention that the program relies heavily on volunteers, particularly college students who often get credit for their work, and on donations from parents and local companies. Still, it costs \"at least $50 a child a year\" to run core operations.

The speakers have disclosed no relevant financial relationships.

Prevention Medicine 2008: Session 22-A. Presented February 22, 2008.

http://www.medscape.com/viewarticle/570741
（奥斯汀，得克萨斯州）——有糖尿病和肥胖风险的小学生可以通过教育获得更健康的生活方式，并且那些信息可以维持至少9个月。这些结果来源于能量计划，出现于2008年的预防医学，即美国大学预防医学的年度会议。
计划的倡导者Art Campfield博士指出，该操作性研究的目的在于观察我们是否可以通过改变在小学阶段教授科学知识的方式来做出一些防御措施。他在柯林斯堡的科罗拉多州大学研究食品与营养，他主要贡献在于研究瘦素在代谢中的作用。
“令人困扰的是Ⅱ型糖尿病和肥胖在很大程度上是可预防的，”他说，“我们需要更清楚的传达生活方式的选择可以预防糖尿病等疾病的发生这一理念。”
Campfield医生说大多数着眼于孩子的糖尿病预防计划都没有涉及到能量平衡的观念，人体科学，血糖的调节，如何预防这些疾病及体象和自尊心。
他主要关注有大量西班牙学生，美国本土学生和来自非洲的美国学生的低收入小学。这些学校中有三分之一到一半的学生超重。他在科罗拉多州，德克萨斯州和西弗吉尼亚州的学校研究了7年之久。
重点在于小组内每周或每隔一周的45至60分钟会议的连续传递的教学方式，每个小组有4到5名来自第二级，第四级，第六级学生和各自的志愿者，这些志愿者通常是一名大学生，尽管高中生，父母或其他人也参与。所有的活动致力于与老师合作（老师可能不在教室），内容是补足其他的教学活动。
该研究得到了国家健康机构的投资，相关资源也可在http://www.programenergy.org.上免费获得。
Campfield医生强调：“一个尺码不能满足所有人。”成功的关键在于与老师建立一个彻底的合作并且为每个级别都设定一个合适的课程计划。“每个级别和教育者形成了一个独一无二的团体，每年每个班都不同。”
基线测试发现二分之一的儿童认识患糖尿病的人，大约三分之一的健康意识和锻炼对于预防糖尿病很重要。但是很少有人知道保持一个健康的体重也同样主要。
和与之相当的管理学校相比，研究者发现该计划使人们对于糖尿病的知识大体上翻了一番。仅有8%的儿童关于该知识的成绩没有提高，而92%的有提高。在该计划完成9个月后，孩子们的知识仍保持。这个结果与每一周或隔一周干涉的结果相似。
这个计划“在个体接受程度上有明显作用”， Campfield医生说，“在这次干涉结束时，他们更愿意接受他们的方式。”
Campfield医生的热情可以被证实，当他补充道，“生活方式的改变是否起作用的辩论已结束。现在不是进行更多的研究的时候，现在需要采取措施教授这个国家的人们每年需要耗费$10,000的疾病大部分可以被预防。”
一个听众建议BMI（身体健康指数）的改变是衡量该计划是否成功的重要手段。“但是无论你的计划对于解决这些巨大复杂的问题多么有效，仅仅有这个计划还是不够的。”
Campfield医生承认了这点。他说，他们把小孩分为肥胖，超重和体重健康组，并且那些经历这个计划的第六级的孩子和随后的孩子们在总BMI值上总体改变很小。那些肥胖或健康的儿童趋向于维持在其固有水平，但这驱使超重的儿童恢复健康水平。他说：“我们正尽力建立一个足够大的N[Stupid]以保证这是一个成功的预防措施。”
他认为对于BMI的强调太多了，并指出其他的因素也应列入考虑，如健康和生活质量的提高。
当被问及到如何扩大这项计划并使之制度化时，Campfield医生说：“关键问题是使儿童感兴趣…这很特别因为大学生来了并且关心与科学毫不相关的事。
他告诉公众健康和预防组织，这一计划主要依赖于志愿者，特别是因其工作得到好评或得到其父母或当地公司自主的大学生。不过，每年的花费还是至少”50美元每个儿童”以使核心组织运作。
演讲者没透露相关的经济关系。
2008 预防医学：22-A期 发表于2008年2月22日