Heart Trouble Can Start in the Young

It was something cardiologist Rae-Ellen Kavey never thought she'd witness.

"For 30 years I have been doing cardiology, and I never thought I would see a child with type 2 diabetes at 10 or 12 years of age," says Kavey, chairwoman of cardiology at Children's Memorial Hospital at Northwestern University's Feinberg School of Medicine in Chicago.

The rising incidence of type 2 diabetes, once called adult-onset diabetes, in young people is just one aspect of the obesity epidemic plaguing the United States. Unfortunately, both diabetes and obesity spell heart trouble, even for kids, she notes.

"Obesity is like a marker for high blood pressure and high cholesterol. Those things all cluster together," Kavey says. "In the old days it was called the deadly triad. I'm seeing it all the time now."

The good news is that damage to arteries is reversible if children just change their behaviors.

Kavey works with her pediatric patients to get them to adopt a weight loss and exercise program. The exercise can be anything they can do in half-hour segments: hula hooping, skipping rope, jazz dancing, karate or a combination.

On the diet side, there are four simple rules:

• Get rid of all drinks with sugar (that means no juice, no Gatorade, no soda, except diet soda, and no milk except skim milk).
• All snacks between meals have to be raw fruit, raw vegetables or air-popped popcorn.
• At mealtime, portions of meat and starch need to be cut by 25 percent (two pieces of toast becomes one-and-a-half). Vegetables and salad fill in any gaps.
• No eating in front of the television. "That combination is the worst thing you could do, sitting still and eating," Kavey says.

It's not easy. One in four of Kavey's patients loses weight, one in four tries but doesn't lose and two out of four never come back. "That's considered pretty good results," she says.

A successful program, Kavey adds, needs to involve the entire family, especially since obese children often have at least one obese parent. "You can't just change the life of one child," she says. "It's the whole family."

Asked about the U.S. Food and Drug Administration's recent approval of the drug Xenical to treat obese adolescents, Kavey says drugs aren't the answer.

"Drugs for adults have been moderately successful," she says. "It's not like drugs are going to transform children who are massively overweight into normal-weight children. The drug has to be combined with diet."