I’m curious: what is her socioeconomic level, and how much “junk food” (highly-processed foods, refined flours and grains, foods containing high fructose corn syrup and/or trans-fats, high sodium, etc.) is in her diet?
Another thing to consider: I seem to recall always having one or two classmates in school who were morbidly obese, but who did not seem to be eating any more or differently than the rest of us. Is there any differential diagnosis (differentiated from grossly overeating) for morbid obesity?
I have few children with morbid obesity and not with syndromes. Most of them have familial obesity,so it must be genetic. The mother is obese,I checked her blood glucose few hours ago,340 mg !! NOT diagnosed type2,father is diabetic.The girl complains of early morning headache with vomiting so she went now to have CT scan brain to rule out cerebral oedema,and ophthalmologist will see her to check papilloedema.Mother was sent to primary care clinic to check her and start on metformin till evaluated completely.The child will stay as in patient to assess her and educate her with family about metabolic syndrome management.
The news reports suggest that we are seeing many children here with metabolic syndrome. Most of the time we see this in lower socioeconomic areas. There are several reasons for this, including possible genetic tendencies (new immigrants from areas where there is a higher risk of metabolic syndrome components); high-carb, high-fat diets; high cost (financially, logistically – have to travel far to get to them – and in terms of preparation time) of healthy foods (fruits and veggies), low-quality of affordable foods (almost always made with high fructose corn syrup, hydrogenated vegetable oils, and lots of dietary sodium), and prevalence of McDonald’s and similar high-fat/low-nutrition fast food establishments.
Here we have the opposite,children with nice pocket money go and buy fast food meals or order by phone( no minimal charge!!),refusing to eat family food.Mothers now go to work leaving maids to feed their kids,have no time to cook or order meals from outside.Fruits are plenty and so are vegetables but who will eat it?,that is the parents complaint all the time…Heading for disaster.
Diabetes is crawling towards me:
1-Arabs are found to be genetically predisposed to type2 diabetes
2-I have family history of type 2 diabetes
3-My weight is increasing
4-My fasting blood glucose is rising
I have to start dieting ( very difficult)
2-I have to move more
2- years ago I started a campaign in my hospital: eat less,walk more,I shed 7Kg in a month and so are many of my colleagues.I have to restart it again…
My Grandround lecture:
I chose metabolic syndrome in children,but though I will talk about it,the Title will be: We Arabs are prediabetic till further notice.
Feel ashamed not to practice what I breach,I gaind few kilos just sitting on computer writing my books,inbetween I read journals or open on my beloved community site here.
Two years back I started a campaign in our great institution Eat less,Walk more,donate the price of one fast food meal to a charity.It was a sucess.We lost weight,felt better,many adults with recent onset of type2 normalized their blood glucose.
My husband and children are sport loving. I have to start the campaign again so we can support each others.
Revelation of the girl’s mother( the girl with metabolic syndrome);
MackDonalds opened in the far north of the kingdom,in every corner,especially within reach of schools.I am still campaigning to ban fast food chains within reach of schools,soft drinks were banned from all schools by the very active great poeple in school health department.
To ban soft drink machines from my beloved children hospital,I wrote a poem: How the soft drink machine has died !!!
Teaching residents today about DKA management, I later mentioned metabolic syndrome,prediabetes and type 2 diabetes,urging them to screen themselves and start modifying their life style,for all,normal,or overweight. We started small supportive weight watchers group today.
This is great, I dream with the time we can do this at large scale. My mom has been trying o loose weight for months… and just keep on gaining weight instead. Last week she and and old friend decided to retire to a small bed & breakfast, and have diet-food prepared for them. And they have been loosing weight¡
They are going out for small walks, they are supporting each other, and it is just the start. However, I realize not everybody can afford that, I wish somehow we could recreate this experience, but make it affordable. That is something going in my mind everyday… we will find a way to make it happen¡
Stressed:
Decisions were taken in the department without discussion with all of us,where is democracy my colleagues? I learnt to comment through poetry and sent it to all in the department and then get out of the way of shocked and angry colleauges.
Teusday: diabetes clinic Today:
Wished to resign and run, run away.Worst senarios today,bad control,missed many appointments…
Just waiting to go home to see my father and family in Egypt in November,the fifth…
Sorry to hear you’ve had a bad day. Welcome to bureaucracy. Poetry is definitely a positive way of dealing with negative emotions; I learned that years and years ago…
Good thing you’ve got that vacation coming up soon
Thank you Tmana & Debb for the kind comments.Diabetes control is a battle that to be won on either side.It is sad when parents neglect their children.Today it was unbeleivable… I feel so depressed.
I can understand. Sometimes, it is not that the parents wish to neglect their children – but that they do not have the time and/or the money to do as well by them as they would like. I see families where there is only one parent, or where both parents have to work two jobs just to afford the rent, and there’s nobody to watch the kids (unless an aunt, uncle, or grandparent is living with them or nearby). People struggle to buy food, and the food they can afford is not healthy, and they don’t have any money left to buy medicine or to take their kids to the clinic.
Other times, it really is the case of the sperm donor and the womb renter, and expectations that the kids can and should fend for themselves. Usually that is a case for a social worker from child protective services.
Physicians’ concepts of “difficult patients” differ.
On the front page of its Health section, the Washington Post (10/21, HE1, Boodman) reports that, while it is important to be “a knowledgeable, assertive patient” who forges “a working partnership with a doctor,” the “path to achieving such an alliance often is not an easy one.” Now, when “Americans are increasingly expected to take responsibility for their health and make complex decisions, and where medical information and misinformation abound – and doctors are feeling squeezed by time pressures – the line between ‘assertive’ and ‘difficult’ can be perilously thin.” There also is no “consensus about what ‘difficult’ means.” For example, some physicians “regard patients with substance-abuse problems or those who don’t take their advice as difficult, while others are bothered by patients who exude a sense of entitlement, or who repeatedly complain about symptoms for which no physical cause can be found.” Still others may just be “advocating for high-quality care” for a relative or for themselves.
