Today was interesting. I am learning a lot at this meeting. One of the things I learned is that 17% children with obesity and type II diabetes will also have a need for insulin injections because they also have type I diabetes! This was a surprise to me and very worrisome. The long term consequences are huge….usually people with type II diabetes get it late in life so the complications that occur between 10 and 30 years after diagnosis are less of an issue but with younger people getting type II diabetes there is a much greater chance we will see blindness, amputation, and kidney disease among much younger adults. Then if you add on top of that pancreatic failure (type I diabetes) the whole process gets accelerated. The other interesting fact is that children who are overweight whose only intervention is seeing a dietician never ever succeed in maintaining weight loss. It is clear that to combat obesity, we must not only focus on diet or exercise or genetics but fundamentally change the way families live their lives….turn off the tv and computer and video games, spend hours outside climbing trees, limit portion sizes to the size of your fist and enjoy the indulgences of life intermittently but not everyday.
I had dinner tonight with the faculty for the meeting I am running and we had wide ranging, spirited discussions about everything from the best form of national health insurance (single payor vs modified free market system that ensures care) to whether or not newborn screening tests for a variety of diseases is really worth not only the cost but the angst that goes along with false positive results. It was fascinating to hear how varied the experiences are across the country and how variable health care coverage is for the most vulnerable Americans: children. We are lucky…..we have jobs and insurance and access to good resources…..so many kids do not. This is especially true for kids with special health care needs, learning differences, and mental or emotional challenges. These are the kids that often fall through the cracks.
I received a very well written and empassioned email from the mother of a patient who is very frustrated with the options for her child in the public school system. Her daughter is very functional in many ways but needs support in areas that are not as visible as some other children and as a result she is having a hard time finding a preschool setting that will meet her daughter’s needs. This is a common issue. Funding for education in Michigan formally begins with kindergarten unless you are in a ‘high risk’ group that qualifies for Head Start there is no mandate that developmentally appropriate schooling be provided. It is incredibly frustrating and problematic. Kids who tend to fall into these gaps are kids with sensory issues, dyspraxia (where you know what you want to say and do but your body just doesn’t know how to do it right), and emotional challenges. Ironically, if you have a stroke that lends you utterly mentally retarded you get all the support you could want but if you are a cognitively normal child with emotional, balance, or more subtly complex language problems you fall through the cracks. I am not sure what we can do about all of this other than be aware of it and advocate to the governmental powers that be to ensure appropriate support but I needed to share some of the challenges. Perhaps by informing everyone about these issues I will at least grow a better understanding of the differences among our children and a foster a greater tolerance of these differences.
I hope that through my practice community, parents who are interested in advocacy issues can connect with each other and through some grass roots planning make some much needed progress toward change. The power of this community we are building is great. I encourage us all to harness it and use it.
That’s all for tonight….
Eat, love and play and each day will be your best!
Molly O’Shea, MD