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The teenager had the kind of story Drs. Francine Kaufman and Anne Peters hear far too often. Adrian Rivera was a chunky but active 15-year-old when he returned to California in late 2004 after two energetic years living on an uncle's ranch in Mexico. But activity turned to torpor as Rivera sat around the house in Whittier, Calif., waiting for school to start. "All I did was eat, sleep and play my PlayStation and Game Boy," recalls Adrian, now 17. In just two months, the 5-foot-9 teen's weight shot from 192 pounds to 255. Alarmed, his parents took him to the family doctor, who diagnosed type 2 diabetes.
Now a patient at Kaufman's pediatric-diabetes clinic, Rivera is another statistic in the nation's diabetes epidemic. The disease is hitting minority communities hard: nearly half of all African-American and Latino children born in 2000 are expected to become diabetic at some time in their lives, according to a projection by the Centers for Disease Control and Prevention. (The ratio for all Americans born that year is expected to be one in three.) Which is why Kaufman and Peters, both from the University of Southern California's Keck School of Medicine, are rushing to find innovative treatments for current patients—and effective prevention regimens to keep at-risk populations from becoming diabetic. "We are at the vortex of the obesity and type 2 diabetes explosion," says Kaufman, a past president of the American Diabetes Association.
Working separately and together, Kaufman and Peters are "definitely on the front lines" of the diabetes fight, says Ann Albright, CDC's director of the Division of Diabetes Translation, which "translates" clinical research into public-health practices. Peters, who treats adults, believes she can deliver quality diabetes care in poor minority communities equaling what she gives paying patients at a USC clinic she directs in Beverly Hills. So, in an effort "to prove you can improve the health of the poorest of the poor," two or three days a week she leads a team that cares for 2,000 working-class immigrant diabetics at an L.A. County-run clinic in predominantly Latino East Los Angeles. Meanwhile, Kaufman, who treats kids, heads the Center for Diabetes, Endocrinology & Metabolism at Childrens Hospital Los Angeles.
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Weight loss, increased exercise and better diets are known to prevent prediabetes—a condition in which blood-sugar levels are only slightly elevated—from becoming the full-blown disease. In 2004, Peters and Kaufman teamed up to study diabetes and tailor solutions in a pair of Los Angeles ZIP codes where the disease ran high, one in Latino East L.A. and another in South L.A. with a mix of blacks and Latinos. They identified lots of problems, including few grocery stores with fresh vegetables and an oversupply of fast-food joints. "It's one thing to say 'eat healthy,' but it's hard when you can't find healthy food," says Peters.
The docs discovered other cultural barriers to attacking obesity. Fast food was a status symbol, especially among new immigrants. Ironically, fear of food shortages may lead some to eat too much. About one third of the American-born blacks and Latinos surveyed said they'd gone hungry at least once in the previous year; half the immigrants said they had. "If I thought I was going to run out of food, would I go on a diet?" asks Peters. "Are you kidding?" Even a healthy disregard for the American obsession with thinness worked against the families. About 71 percent of the moms thought their kids were of normal weight—but in fact nearly half to two thirds of them were overweight or obese. Kaufman sees the same cultural anomaly when families bring toddlers for checkups. "The baby comes in and he's a butterball, but if you ask Grandma, he's not eating enough," she notes.
To counter the problems, the team looked for ways to teach healthy food habits to the community. When a farmers market started in East L.A., dietitians began offering cooking classes to show moms how to use the fresh foods. The team also helped set up a new farmers market in Watts this summer. In addition, they are testing a hospital-based diet-and-exercise education program called Kids N Fitness (which pairs exercise classes for high-risk overweight kids with dietary instruction for parents) to see if it can be delivered successfully in parks and schools.
Kaufman also heads a national study team to see whether making innovative changes in school cafeterias, health classes and gym programs can lower obesity and blood-sugar levels for middle-school kids. Seventh-grade students at 21 schools, including Long Beach, Calif.'s Cecil B. DeMille Middle School, are entering year two of a three-year trial to eat better and play harder; at graduation in 2009, their results will be compared with a control group of kids in 21 similar schools (most of which have a majority of minority students, including high-risk Asian and Native American populations). The need is there: fully half of the 6,300 children enrolled in the study last year were overweight or obese. "Our hope is that if it is successful, we'll be able to say that this is what schools should look like," says Kaufman.
Last year participating sixth graders at DeMille traded Gatorade and Flamin' Hot Cheetos for healthier lunches that include water and low-fat baked chips. But the most obvious changes are coming in gym classes, which in many schools offer no more than 15 minutes of actual exercise. The new regimen: keep the kids' heart rates above 140 beats per minute for 25 to 30 minutes. So when Maggie Del Rio taught softball last spring, no one stood around waiting for a turn at bat. Students rotated stations as they threw balls while running in lines, ran laps, jumped hurdles and sprinted the bases. Eduardo Chacon, 13, wore a heart-rate monitor as he rounded third and headed for home. What's his rate? "192!" he said, smiling.
Doctors know how to treat type 2 diabetes in adults, but they don't really know that much about treating it in children because the phenomenon is relatively new, says Kaufman. She's study chair for a new NIH-funded trial to find out what works for kids with type 2. It will track the progress of 750 type 2 diabetics ages 10 to 17 for five years to see which of three treatments best controls blood-sugar and insulin levels: one of two drug therapies or a drugs-plus-intensive diet-and-exercise plan. One of the patients in the third group is Adrian Rivera, who now sticks to a 1,000- to 1,300-calorie daily diet, plays soccer frequently and reports his progress (he's down to 236 pounds) to lifestyle coach Socorro Hernandez, who praises Rivera for "working very hard."
Marsala Esquivel, 16, is another patient working hard in the trial. The Los Angeles teen learned she had diabetes at 14—just as her older sister, Genavi, found out she was dangerously prediabetic. Since then, both girls have lost weight, improved their diets and started exercising. The Esquivels bear out researchers' belief that many type 2 diabetics come from families hit hard for generations. Mother Marie Gutierrez was diagnosed in her early 30s; three grandparents had the disease, including a grandfather killed by complications several years ago. Medical science may not be able to end that cycle entirely, but if Kaufman, Peters and others have their way, Marsala will be able to control her disease for many decades, while Genavi—and millions of others—won't get it at all.
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