Dr. Antonio Convit awoke suddenly one night, unable to sleep. His research findings were running through his mind. He had been studying overweight and obese children who were developing pre-diabetes (called insulin resistance) and type 2 (non-insulin dependent) diabetes. It is well known that obesity greatly increases the risk of diabetes in children (and adults). But what relation obesity and diabetes have to the mental functioning of the developing brains of children and adolescents has been uncharted territory -- exactly where a scientist like Dr. Convit and his research team would want to go.
They began their work studying obese adolescents with type 2 diabetes. They wondered if serious weight gain and diabetes reduced intellectual performance in youth. To answer this critical question, they would test the brain's functioning by measuring intelligence, reading, spelling, vocabulary, reasoning, memory, attention, concentration and mental efficiency. They would also do imaging of the brain by MRI (Magnetic Resonance Imaging, a scanning technique where the brain can be safely studied) to see if there were reductions in its size or capacity to function, of course factoring in age, that might be related to lower levels of mental performance.
Their results show that the adolescents with type 2 diabetes did more poorly across the board on mental performance tests. In addition, these same youth showed smaller brain volume for the entire brain and the frontal lobes, where much of our reasoning occurs. The frontal lobes are the last part of the brain to mature, making it is highly sensitive to change during adolescence. The abnormal findings Dr. Convit found occur more in obese diabetic youth than in (matched) youth who also were obese but did not have diabetes (or pre-diabetes -- in which the body has developed insulin resistance).
Obesity in youth has tripled in the past 30 years, with one in three three high school students now overweight or obese in the United States. Minority groups show even more disturbing trends with one in two Hispanic and four in 10 black youths affected. Obesity is the road to insulin resistance and diabetes, with their well known adverse effects on blood vessels and the heart -- which shorten life and erode its quality along the way. What is new, however, is that obese, diabetic youth also have their brains impacted and appear to have difficulty learning and succeeding in school.
A survey by the New York City Department of Health and Mental Hygiene (NYC Vital Signs, June 2009, Volume 8, No.1) examined public school children from kindergarten through 8th grade and found nearly 40 percent overweight or obese. The epidemic of obesity is greater in NYC than it is nationwide, but not by much. The epidemic has spared no one: Boys and girls of various ethnicities.
The NYC survey focused on Body-Mass-Index (BMI, which is a measure that takes weight and height into account) and physical fitness in this age group; it showed that overweight and obese youth (BMI equal or greater than 30) had lower levels of fitness, and that physically fit children did better on tests of English Language Arts (ELA) and Standardized Math tests -- both established measures of school performance. The City Health and Mental Hygiene Department recommended, as a result, that parents, schools and health care providers need to help children be fit by engaging in daily physical activity. In addition, the report stressed healthy eating habits, including healthy meals at home, and "...don't let your children drink their calories" referring to the way that high calorie, sugary beverages cause weight gain in youth.
Dr. Convit has taken his research findings beyond his laboratory and academic work at the Nathan Kline Institute -- a research institute of the NYS Office of Mental Health (DISCLOSURE: The Table of Organization of OMH will show this Institute reporting to me) and the New York University Langone Medical Center. He began The BODY Project: Banishing Obesity and Diabetes in Youth. This program is working with adolescent students at two NYC schools, in Manhattan and Brooklyn, to medically screen, engage and help minority youth with excess weight and their families change how they eat, become more physically active, and take care of their health and wellbeing - today and for the future. The BODY Project aims to improve health and brain functioning (and thus school performance) in these youth.
Dr. Convit's work is revealing a gradient where learning difficulties increase as youth go from lean, to obese without insulin resistance, to obese with insulin resistance but not yet diabetic, to those who are obese and have diabetes. It appears that every step beyond being lean means the brain works less well and performance at school can suffer.
This is what I think is waking Dr. Convit up at night. Imagine if there was a way to improve school performance now, not just prevent heart disease years from now? Imagine if success in school, not just a smaller clothing size, awaited adolescents who with direction and support became fitter and shed pounds. Imagine if school test scores increased as BMI scores decreased. I would be restless too if I saw a way by which one third of American high school students, and others even younger, could become more mentally capable, more competitive and more successful. That would be a real wake up call.
The opinions expressed herein are solely my own as a psychiatrist and public health advocate.
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