Physician-researcher tackling diabetes, obesity among Latino kids
Dr. Roberto Trevino, who emerged from a San Antonio housing project to become a doctor with clinics in the city's most disadvantaged neighborhoods, got tired of "waiting for diabetic people age 40 and older to walk into the clinic, going blind and losing limbs."
So, in 1994, he created Bienestar, a school-based diabetes prevention program to boost kids' fitness and healthy eating.
Today, 27 Texas school districts, many in low-income, Latino areas, use Bienestar to help 150,000 elementary- and middle-school students.
"I felt somebody had to go back into those poor populations and reach out, and start changing behavior at an early age," said Dr. Trevino, a Salud America! member who runs the San Antonio-based Social & Health Research Center, a nonprofit that aims to prevent diabetes and obesity in communities and schools using health programs like Bienestar.
About 91 percent of all causes of type 2 diabetes are attributed to a diet high in saturated fat and sugar, low dietary fiber intake, low physical activity and overweight, according to a study published in the New England Journal of Medicine in 2001.
Bienestar uses social cognitive theory—the idea that an individual's knowledge acquisition can be related to observing others in the context of social interactions—to coordinate four social systems that influence children's health behaviors: health class, physical education, food service and home.
The program produces four types of bilingual materials: health curriculum for children and teachers in each grade from kindergarten through eighth grade; booklets on physical education activities; a cafeteria manual for food service staff; and a curriculum for after-school caretakers. The program records children's measurements, including body mass index, before the school year starts and again when it ends.
"Students participating in the Bienestar program have reported increased dietary fiber intake, increased fitness levels and decreased blood glucose levels," said Dr. Trevino.
Outcomes like those, which were published in the Archives of Pediatrics in 2004, led to the development of Bienestar as an approved Texas Education Agency-coordinated school health curriculum that is now used across Texas.
The program's latest finding is quite surprising—overweight children aren't necessarily overeating.
That new study, published in the November 2008 issue of the Journal of the American Dietetic Association, found that about one-third of 1,402 San Antonio fourth-graders, mainly from low-income, Latino families surveyed through the Bienestar program, were obese and highly sedentary. But 44 percent of these children actually consumed fewer calories than minimum guidelines, and most of the other 56 percent were within the recommended calorie-intake guidelines.
It's just that what those children are eating is very unhealthy, such as foods high in saturated fat and sugar, and foods that lack essential nutrients like magnesium, calcium, phosphorus and potassium, said Dr. Trevino, who led the study.
A combination of low levels of physical activity and unhealthy food means that even when kids are eating the recommended number of calories daily, their health may still be at risk, the researchers concluded.
Now Dr. Trevino and his team are working, through Bienestar, to promote calcium-rich foods (milk, yogurt, cheese, white beans, almonds, broccoli, oranges and spinach), phosphorus-rich foods (baked beans, whole wheat bread, oranges, cauliflower and ham), potassium-rich foods (sweet potatoes, white beans, yogurt, tuna, bananas, spinach, peaches, milk and squash) and magnesium-rich foods (bran cereal, oatmeal, spinach, bananas, mixed nuts, chicken and turkey).
Dr. Trevino also is working to extend the Bienestar program in schools in Mexico.
"There's no limit to where this program can have benefits," he said.
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