Health Education

Overweight Kids at Risk of Diabetes

An overweight teenager holds a giant soda in one hand, a bag of fries in the other. It’s a scene that has become all too common, and it may be contributing to the increased prevalence of type 2 diabetes among American youth.

Type 2 diabetes was once known as adult onset because it is normally diagnosed among adults in their 50s or 60s, often after years of poor eating and exercise habits. As fat accumulates, cells gradually become less sensitive to the action of insulin and ineffective in converting blood sugar into energy.

Although young people are frequently diagnosed with type 1 diabetes, an autoimmune disorder affecting insulin-producing cells of the pancreas, type 2 diabetes was almost never seen among children until the early 1980s. Over the past two decades, during a period when children have become increasingly overweight, type 2 diabetes has increased at a distressing rate among this age group. It now accounts for 40 to 50 percent of all newly diagnosed diabetes cases among youth.

Many of these children have parents or other close relatives with type 2 diabetes, and the majority come from high-risk ethnic groups such as Native Americans, African Americans, Hispanics and Asian/South Pacific Islanders. Outweighing possible genetic factors, however, are preventable lifestyle choices: poor eating habits and lack of physical activity.

Most of us know the scenario. Children today are more likely to get their hearts racing with video games or TV shows than playing kick ball or soccer. In single parent homes or those in which both parents work long hours, youngsters may be expected to spend their after-school hours inside the home rather than on street corners.

Anxious to improve academic performance, schools no longer require physical education; recess time for younger students has been cut. Lunch choices include many high fat items, and candy and pop machines line the halls. In order to raise money, some schools even sell exclusive fast food and soft drink contracts–increasing the availability of high-fat, high-calorie products and sending a subconscious message to students.

With about 40 percent of young people either overweight or obese, the U.S. Surgeon General earlier this year issued a report, “The Surgeon General’s Call to Action To Prevent and Decrease Overweight and Obesity.” Doctors are urging parents to be aware of the eating and exercise patterns of their children and alert to the signs of diabetes.

Know the Signs

Nearly all children with type 2 diabetes are obese–some weighing as much as 200 pounds by their early teens. Many develop an area of thick, darkened skin (known as acanthosis nigricans), usually at the back of the neck or around the armpits–a sign of insulin resistance.

Unlike type 1 diabetes, the onset may be gradual. Typical signs of diabetes–increased thirst and urination–may not always be noticeable, except perhaps through an unexpected episode of bed wetting.
Among adults, type 2 diabetes can be successfully managed over many years, sometimes through diet and exercise alone. Children and adolescents diagnosed with the disease today, however, seem to be showing severe complications at a very early age.

One recent study of 51 patients diagnosed before age 17, found an unusually high rate of complications and miscarriages. Seven of these patients died before age 33, and three were on dialysis for kidney failure. One young woman lost her eyesight, and one had a toe amputated. From 56 pregnancies, only 35 live births were recorded.

It should be noted, however, that most of these subjects were diagnosed relatively late in the disease process and had poor control of blood sugar. With early detection and treatment, most of the complications could have been avoided.

The majority of children with type 2 diabetes have at least one parent or close family member with the disease. Of all risk factors, the strongest is having a mother with gestational diabetes (developing during pregnancy) or type 2 diabetes diagnosed before pregnancy. Both high and low birth weight are associated with an increased risk, but breast feeding seems to provide some protection. Onset of diabetes is particularly high around the time of puberty, a time when body cells have an increased resistance to insulin, perhaps related to increased levels of human growth hormone.

Among high-risk groups such as Native Americans, the burgeoning incidence of type 2 diabetes may be a result of changing lifestyles coupled with a strong genetic predisposition. Studies have shown that some ethnic groups, including African Americans, are more likely than others to become insulin resistant when they are overweight or physically inactive.

The American Diabetes Association recommends that children who are obese and have a family history of type 2 diabetes plus signs of insulin resistance such as acanthosis nigricans should be screened at age 10 and every two years thereafter. Many doctors recommend screening for any youngsters who are severely overweight and have at least two other risk factors.

Once diabetes is diagnosed, initial treatment typically involves diet, exercise and education. Patients must monitor their blood glucose and know how it is affected by what they eat and what they do. Health professionals realize the need to respect individual and cultural preferences when recommending dietary changes.

If diet and exercise are inadequate to control blood sugar, oral medications such as metformin (approved in December, 2000 for use in children) may be prescribed.

Prevention is crucial but never easy. At any age, weight is best controlled through increased physical activity plus a diet that stresses fruits, vegetables and fiber over high-fat, high-calorie foods. Surveys show, however, that children are less likely than adults to get the recommended levels of fruits and vegetables.
Harping at children and adolescents about what they eat and what they do is usually counter-productive. Parents can, however, provide a good example themselves and make sure that healthy food choices are available.

Diet drugs and high protein or very low calorie weight loss plans are unsafe for children (as they are for most adults).

Most health professionals recommend a school or community-based approach promoting improved diet and exercise patterns for all youth. Schools should re-consider their policies about recess and physical education. Fruits and juices should be available at lunch counters and snack machines. Even small changes in eating and exercise habits can make a big difference.

REFERENCES:

“Alarming Increase in Children with Type 2 Diabetes Is a Wake-Up Call,” Diabetes Week, July 8, 2002.
American Diabetes Association, “Type 2 Diabetes in Children and Adolescents,” Diabetes Care, March, 2000.
Jeff Bauer, “Pre-Diabetic Condition Is Found in Many Obese Children and Adolescents,” RN, June, 2002.
Doug Brunk, “Type 2 Diabetes Complications Hit Young Adults Hard: Childhood Type 2 Diabetes Later Resulted in Kidney Failure, Blindness, and Death,” Pediatric News, July, 2002.
“Consensus Statement on Diabetes in Children,” Patient Care, May 30, 2000.
A.J. Drake, et al, “Type 2 Diabetes in Obese White Children,” Archives of Disease in Childhood, March, 2002.
“Educators Should Lead Charge To Cut Diabetes Incidence,” Diabetes Week, April 1, 2002.
“Emerging Diabetes Epidemic Triggers National Call for Screening,” Diabetes Week, July 1, 2002.
“A GP’s Guide to Type 2 Diabetes in Children,” Pulse, March 4, 2002.
Terri Kordella, “Obesity in Toddlers: Genes and Chemistry, Not Lifestyle?” Diabetes Forecast, September, 2002.
Stephen J. Lurie, “Treatment of Type 2 Diabetes in Children,” JAMA, February 13, 2002.
Matthew Neff, “Incidence of Type 2 Diabetes Rising Dramatically in Children,” American Family Physician, November 15, 1999.
Elaine K. Ruiz, et al, “Type 2 Disease in Children,” RN, October, 2001.
“Significant Number of Children at Risk for Severe, Potentially Preventable Complications,” Diabetes Week, June 3, 2002.
Ranjana Sinha, “Prevalence of Impaired Glucose Tolerance among Children and Adolescents with Marked Obesity,” JAMA, May 15, 2002.
T. Kue Young et al, “Type 2 Diabetes Mellitus in Children: Prenatal and Early Infancy Risk Factors among Native Canadians,” Archives of Pediatrics & Adolescent Medicine, July, 2002.