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July 25, 2000

Genetics and Heredity, Other Illnesses

Question from Phoenix, Arizona, USA:

I was 32 when I had my daughter (now three years old). I had gestational diabetes during the pregnancy and took insulin twice a day. I now know that it was likely brought on by my problem with Polycystic Ovary Syndrome (excess facial hair, excess weight, acne, lack of periods, etc.) and the inherent insulin resistance I had/have. Should I be concerned about my daughter either (1) developing diabetes (type 1 or 2), or (2) developing PCOS like I did?

Answer:

Type 2 diabetes tends to run in families, but can partially be prevented by avoiding obesity. Polycystic ovary syndrome also is related to obesity. There is a complex relationship between obesity, insulin resistance, and polycystic ovary syndrome. It is not clear which of these three trigger the other 2 problems. Right now, the only thing you can do to try and prevent all three problems is control her weight to avoid obesity.

TGL
Additional comments from Betty Brackenridge, diabetes dietitian:

I congratulate you on your concern about these issues at this point in your child’s life. It is much better to do all you can to prevent problems, rather than trying to respond to them later. However, trying to manipulate weight in children is not a straightforward task. And if handled incorrectly, it can actually make matters worse. There is excellent evidence that inappropriate attention to food restriction, dieting or body weight by the parents of young children is associated with subsequent development of eating disorders and an inability to maintain a normal, healthy weight in adolescence and into later life. The bond between parent and child is intimately tied up with feeding. The parent’s role is to nurture, not to become the “food police.” So, appetite, hunger, and food intake regulation are processes that can and should be internalized — not externally controlled. The parent’s job is to get the “right” foods on the table for the child to choose from and then let the child’s appetite dictate how much of those available foods he or she will eat to manage hunger. By the “right” foods I mean, a variety of healthful foods from all the food groups. Include sweets in age appropriate portions. To do otherwise is to give candy, cakes, and cookies huge appeal and power in the child’s eyes.

But beyond how to manage food, the best advice I can give you is to encourage a physically active life for your child. Get out and walk, skate or climb on the monkey bars with her. Don’t make it a punishment to lose weight — remember, we used to call that stuff playing! And if she’s doing it with mom and dad, so much the better. Limit TV viewing to no more than one hour daily. Food is only one half of the weight gain equation and by far the harder one to manage without causing harm.

And please understand that your child — as the baby of a gestational diabetes pregnancy and with a strong potential for insulin resistance — is likely to be a “round” kid. The greatest gift you can give her is to accept her the exact shape she is, communicate your love and acceptance of her body so that she can do the same. That factor alone will have important power to help her maintain a more comfortable and normal relationship with food as she grows.

BB