Dr. Garry Shen

Dr. Garry Shen and his colleagues are working to break the cycle of obesity and diabetes in Aboriginal women and their children

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Obesity and its shadow, type 2 diabetes, are spreading across Canada. Together, they have major consequences for our health and health-care system. We know that these are preventable diseases, but what are the best prevention strategies? Dr. Garry Shen and his team at the University of Manitoba are working with pregnant Aboriginal women with a high risk of developing diabetes to find a solution.

"We all agree that if you want to prevent diabetes, you should start early, but the question is how early?" says Dr. Shen. "We know that overweight women tend to get maternal obesity and gestational diabetes, and then they tend to deliver big babies. Then these big babies, when they grow up, become (overweight) too. We call this the maternal obesity cycle."

Dr. Shen and his colleagues think that the best way to break this cycle is through diet and physical activity. So he and his research team developed a diet and exercise program to help pregnant women increase their regular physical activity and improve their diet to reduce their risk of obesity and diabetes. They began their study in the city of Winnipeg, where they recruited more than 200 Aboriginal and non-Aboriginal women who were either randomly assigned to participate in an exercise and education program or to a control group.

"We hired a (physical) trainer and prepared an instruction video specifically for pregnant women," says Dr. Shen. "The City of Winnipeg provided us with a gym downtown, so we could provide free exercise classes for the women each week."

In addition to the exercise classes, they offered free nutritional counseling. So far, they have found that the exercise and education program reduces the risk of maternal obesity, particularly for Aboriginal women.

This finding could be very important for Canada's Aboriginal communities, which have diabetes rates three to five times higher than that of the general population. Pregnant women in these communities have a particularly high risk of developing obesity and pre-diabetes. And this is not only a threat to the mothers' health; it may also be perpetuating an intergenerational cycle of obesity and type 2 diabetes.

Dr. Shen and his research team are taking the knowledge gained from their urban study and adapting it to create similar programs in several rural First Nations communities throughout Manitoba. They've altered the diet and exercise recommendations to take into account the smaller variety of foods available to rural women and the limited availability of exercise facilities. The research team also developed partnerships with the First Nations communities and obtained approval of the communities' Band Councils to conduct the study.

"We're also training one or more local research assistants in each of the First Nation communities. We train them to not only help with this project, but so that in the future they can independently maintain the program in their community. We think that's most important," says Dr. Shen.

Mandy Armstrong, a project coordinator for the Sandy Bay First Nation, says the program has helped build awareness in her community about the importance of diabetes prevention.

"The women really seem to enjoy it, and they get a better idea of the relationship between diet and activity and diabetes," says Armstrong.

The Study

Dr. Shen and his colleagues established the Impact of Diet and Exercise Activity on Pregnancy Outcomes (IDEA) study in 2004 with the goal of preventing and reducing type 2 diabetes in pregnant women. The IDEA group includes scientists from a variety of research backgrounds, including Drs. Sora Ludwig (endocrinology), Phillip Gardiner (kinesiology), Gustaaf Sevenhuysen (nutrition), Heather Dean (pediatrics), Sharon Bruce (Aboriginal community health), Elizabeth Sellers (pediatrics) and Margaret Morris (obstetrics & gynecology), and community health workers who are trying to combat obesity and diabetes.

With support from the Canadian Institutes of Health Research, Dr. Shen's team studied their exercise and education program and found that it reduced excess weight gain in the pregnant women living in Winnipeg, compared to a similar group of women not in the program (the control group). They also found that many women wanted to stay in the study after they had their babies, raising the possibility that this program could be beneficial for non-pregnant populations trying to reduce their risk of obesity and diabetes.

Their next step is to examine the effectiveness of their program in rural First Nations communities. They will compare baby weights and diabetes rates in the rural communities before and after the program was introduced to see if there was any impact. The results of their initial pilot study show that there is a need for this type of program in rural communities, and that the program is feasible. Dr. Shen and his colleagues plan to expand to more communities and continue to explore the benefits of the program to Aboriginal women and children.

"Once we have evidence that our program is effective, we will share it with other rural Aboriginal communities and with health authorities in other provinces," says Dr. Shen.