Obesity, an excessive amount of body fat, boosts the risk of diabetes, heart conditions and many other diseases. Nearly one-fifth of American children are overweight or obese, according to the Centers for Disease Control and Prevention (CDC).
Type 2 diabetes was once labeled adult-onset diabetes, but that term no longer applies. As the incidence of childhood obesity has risen in recent decades, so has the number of children diagnosed with type 2 diabetes. The CDC now estimates that one out of three children born in 2000 will develop diabetes.
Obesity can also cause a phenomenon called double diabetes, in which children with type 1 diabetes who gain weight develop insulin resistance. Obesity might also cause an earlier onset of type 1 diabetes.
Obesity is a health threat in anyone who has or is at risk for diabetes, and improving obesity statistics has become a priority for health agencies and professionals.
About childhood obesity and diabetes
About two-thirds of American adults and almost one-fifth of those ages 6 to 19 are overweight or obese, according to the Centers for Disease Control and Prevention (CDC). The percentage of young people who are overweight has more than tripled since 1980, the agency reports. The International Obesity Taskforce warns that 10 percent of school-age children worldwide are overweight or obese, with rates continuing to soar. Health experts are concerned because obesity is the leading controllable risk factor for type 2 diabetes.
Obesity carries a fivefold greater risk for developing type 2 diabetes. But the risk is not confined to obesity, which is a body mass index (BMI) of 30 or greater. Being overweight (defined as a BMI of 25 to 29) also increases the risk of diabetes.
The CDC estimates that one out of three children born in the year 2000 will develop diabetes sometime during their lifetime. The estimate is higher for racial minorities.
Unless this trend is reversed, these numbers will increase by 165 percent by 2050, according to the agency.
Obesity may also lead to a phenomenon called double diabetes, in which children with type 1 diabetes develop insulin resistance. Obesity has grown more prevalent in people with type 1 diabetes along with the general population. Excess fat makes it harder to use insulin. Excess weight may also cause the pancreas to deteriorate. Recent research suggests that obesity might cause an earlier onset of type 1 diabetes.
Childhood diabetes is a particular concern because the longer a person has diabetes, the greater the risk of serious complications. This can include damage to the eyes, nerves, heart, blood vessels, kidneys and skin. Some physicians are seeing teenagers who have already developed what were once considered long-term complications of type 2 diabetes.
The CDC reviewed the discharge records of hospitals nationwide from 1979 to 1999 among children ranging ages 6 to 17 and analyzed the results for all obesity-related illnesses. The researchers found that the incidence of:
Diabetes had nearly doubled
Obesity and gallbladder disease tripled
Sleep apnea increased five-fold
The CDC found that these illnesses in children combined to create hospital costs that have tripled as a direct result of childhood obesity. In addition to the high cost of health care for these children, there is an even greater cost in human life. For the general population, the National Institutes of Health estimates that obese people have a 50 to 100 percent increased risk of death compared to people of normal weight.
Risk factors and causes
Overeating, poor diet and lack of exercise explain most of the increase in childhood obesity and type 2 diabetes. Genetics also plays a role, and other factors include race, ethnicity, culture and socioeconomic status. Obesity and diabetes are more common in Hispanics, black Americans and other racial and ethnic minority groups. Also, overweight parents are more likely to have an overweight child.
For children and adolescents who are severely obese, insulin resistance and prediabetes are common. These are risk factors for type 2 diabetes. Insulin resistance is a condition in which the cells have difficulty using insulin, a hormone produced by the pancreas to supply the cells with glucose (blood sugar) for energy. Glucose starts to build up in the blood, which can lead to type 2 diabetes.
The American Heart Association (AHA) estimates that more than 60 million Americans have insulin resistance and that at least 25 percent of them will go on to develop type 2 diabetes.
Obese children face higher risk of metabolic syndrome. This cluster of conditions includes controllable risk factors for heart disease, many of which are also risk factors for diabetes, including unhealthy levels of blood fats (dyslipidemia), high blood glucose (hyperglycemia), high blood pressure and overweight or obesity. The AHA has reported that about 1 million American children between 12 and 19 years old, or about 4.2 percent, have metabolic syndrome. About 74 percent of the 1 million were classified as overweight, and an additional 25 percent were at risk for becoming overweight. The AHA also reports one in 10 children studied proved to have metabolic syndrome.
Many of the factors behind childhood obesity and diabetes involve eating habits, such as:
Increased portion sizes
Diet high in cholesterol and saturated fats
Diet high in processed starches and sugars
Diet low in fiber and vegetables
Increased consumption of soft drinks
Increased consumption of fast food
Consuming more fats, sugars and soft drinks while in school
Children are also exercising less. Computers, video games and television have replaced outdoor play for millions of children. Several studies have shown that fewer than half of the nation's schoolchildren participate in daily physical activity. The American Dietetic Association suggests parents involve children in meal planning, portions and also become a positive role model for good nutrition and exercise.
Other factors in obesity and associated increased risks of developing type 2 diabetes include:
Lack of muscle mass. Muscle burns calories at a higher rate than other tissues, which helps manage weight.
Medications. Some medications, such as corticosteroids, certain antidepressants and antihistamines, may cause a person to add weight.
Psychological factors. Some children eat out of boredom, sadness, stress or anger.
Diseases. Conditions including hypothyroidism, polycystic ovarian syndrome and Cushing’s syndrome have been shown to contribute to obesity.
Signs and symptoms of obesity & diabetes
More than 21 million Americans have diabetes, but about a third of them do not realize they have it. Symptoms often do not appear until complications begin to set in.
Some of the most common factors associated with the development of diabetes include:
Increased hunger (polyphagia)
Increased thirst (polydipsia)
Increased urination (polyuria)
Fatigue
Blurred vision
Rapid, unplanned weight loss
Cuts or sores that are slow to heal
Frequent infections, such as urinary tract infections and yeast infections
In addition to possibly developing diabetes, children who are overweight or obese can experience other health problems. These include:
Problems with bones or joints
Shortness of breath during exercise or sports, increasing the risk of asthma
Sleep apnea
Early maturity, including a younger age at puberty, irregular menstrual cycles and excessive growth of body hair
High blood pressure
Insulin resistance
Dyslipidemia (unhealthy levels of cholesterol and other blood fats)
Liver problems
Depression due to poor body image
Pseudotumor cerebri (this rare condition, not always related to obesity, presents with increased intracranial pressure, leading to headaches that could cause blindness)
Diagnosis methods for obesity & diabetes
A physician can determine if a child or adolescent has diabetes, is overweight or is obese.
The most common standard for measuring obesity has been the body mass index (BMI), a calculation based on an individual’s weight and height. Children who are at or above the 95th percentile for BMI for their age are considered obese. Those who score between the 85th and 94th percentile are considered overweight. Another assessment tool is the waist-hip ratio, which divides waist circumference by hip circumference.
Parents who are concerned that their child may be overweight and thus at risk for developing type 2 diabetes should schedule an appointment with the child’s pediatrician.
The office visit will likely include a physical exam and medical history. This will include questions about a history of:
Family members who have diabetes
Black American, Hispanic, Native American, Asian American or Pacific Islander heritage
Birth weight under 5 pounds or over 10 pounds
Elevated glucose (blood sugar), elevated blood pressure, unhealthy levels of cholesterol or high levels of triglycerides
Glucose tests and often other blood tests are also performed when diabetes is suspected.
Treatment and prevention
Diet and exercise are common ways to treat and prevent childhood obesity and diabetes. Even modest weight loss and a modest increase in daily activity can reap dramatic results.
The Diabetes Prevention Program showed that losing 10 or 15 pounds and light to moderate exercise for 30 minutes a day for five days each week reduced adults’ risk of developing type 2 diabetes by nearly 60 percent. However, because children are still developing, some experts do not recommend weight loss for them unless obesity is severe or involves complications.
Other treatment options for diabetes may include antidiabetic agents (some of which also help control weight) and insulin.
Patients considering weight-loss drugs or supplements marketed as weight-loss aids are urged to first consult their physician about the risks and side effects.
Even with its risks and side effects, weight-loss (bariatric) surgery has become an increasingly popular option to treat morbid obesity in adults and has resolved some cases of type 2 diabetes. The U.S. National Institutes of Health has launched the Teen Longitudinal Assessment of Bariatric Surgery (LABS) study to investigate whether these procedures are appropriate treatment options for obese youths.
Some states are trying to reduce childhood obesity and diabetes by:
Advising parents to start at home - involving the entire family in eating healthy meal planning, food shopping and exercising
Advising parents to set time limits for computer use and television viewing
Reviving physical education in schools
Promoting opportunities for sports and exercise
Improving foods offered by school cafeterias
Restricting vending machines
The U.S. National Institutes of Health (NIH) is studying type 2 diabetes in young people. The TODAY study (Treatment Options for type 2 Diabetes in Adolescents and Youth) began in 2004 and is projected to continue through 2010. Factors being studied include:
Safety of treatments
Effect of treatments on insulin resistance
Exercise and eating habits
Risk factors, including nerve, cardiac, eye and psychological
Treatment costs
Effectiveness of family and peer support
The main goal for the TODAY study is to establish how well and how long various treatments control glucose (blood sugar).
The NIH and other government agencies released a report in 2005 that provided updated guidelines to prevent obesity. Many of the recommendations centered on a sensible diet and on being particularly active most days of the week (30 minutes a day to reduce the risk of chronic disease, 60 minutes or more to maintain or lose weight).
The report also recommended that:
The U.S. government makes prevention of childhood obesity a national priority.
Industries promote healthful eating and physical activity.
Nutrition labeling be clear so parents and youths can make informed choices.
Marketing and advertising to children minimize risk of obesity.
A long–term federal public relations campaign focusing on obesity prevention in children.
Governments and community groups promote healthful eating and physical activity.
Governments, community groups and developers create recreational opportunities.
Healthcare professionals and organizations including insurers track body mass index (BMI) and establish programs on obesity prevention.
Schools make it easy for students to eat well and be physically active. Parents should promote good eating and physical activity behaviors at home.
Questions for your doctor
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients (or parents) may wish to ask their doctor the following questions about childhood obesity and diabetes:
Should my child be tested for diabetes? If so, at what age?
If my child is overweight, is it safe to start a weight-loss program? If so, which program do you recommend?
What can I do to improve my child's eating habits?
What exercise program do you recommend for my child?
Should my child have a checkup before starting an exercise program?
If my child has type 1 diabetes, can weight gain lead to double diabetes? What exactly does double diabetes mean?
Should I use the body mass index chart or waist-hip ratio for my child? How often should my child be weighed?
How can I avoid overemphasizing issues of weight and body image but at the same time get my kids to practice healthy habits?
Can my child's diabetes medication or other medication contribute to weight gain or weight loss?
If exercise and sensible diet don't work, should weight-loss medications be considered for my child? Are there any we should avoid? Are weight-loss supplements safe or useless or dangerous?
If my child is severely obese and can't lose weight any other way, is surgery an option? If so, is my child a candidate for the Teen Longitudinal Assessment of Bariatric Surgery study?
