Diabetes is on the Rise in Childhood and Adolescence

Diabetes is on the Rise in Childhood and Adolescence

by | Sep 8, 2021 | NUTRITIONAL-HEALTH

When kids come up against that common eat right and exercise refrain, they may be all too apt to brush health concerns aside as something only adults have to consider. Heart issues, kidney problems, and especially type 2 diabetes — those words have an “adults only” connotation.

However, the potential to develop type 2 diabetes in adulthood or even earlier comes with a clear link to overweight and obesity at young ages. With it comes an elevated risk for associated health complications, too. While research has indicated some alarming trends, there are also promising findings that hint at the opportunity for individuals to make sustainable change.

Sustainable change isn’t about simple calorie counting — where those calories come from can have just as big an impact on overall health. Families can have fun experimenting with recipes and food choices to give kids the power to view nutrition as a holistic part of their everyday routine.

Prediabetes and Type 2 Diabetes Cases on the Rise

Type 2 diabetes, a disease once known as adult-onset diabetes, has started to impact young people more and more. Recent research paints an increasingly unsettling picture.

A 2019 study published in JAMA Pediatrics found nearly 1 in 5 adolescents are already living with prediabetes, with the percentage of kids between the ages of 12 and 18 with prediabetes higher in those with obesity. Prediabetes, a health condition characterized by higher-than-normal blood sugar levels, can lead to type 2 diabetes and may offer an early window into what’s to come.

But it’s not just prediabetes acting as a glimpse of a problematic but distant future. Researchers are also seeing a shift in type 2 diabetes prevalence in youths. A CDC report from 2020, for example, found the rate of new type 2 diabetes cases for young people under 20 years old in the United States increasing 4.8% per year.

Obesity and Overweight As Diabetes Risk Factors

Though not the only factors, obesity and overweight are helping to spur the rise in type 2 diabetes among children and adolescents. A 2005 review in the journal Pediatrics examined the ongoing trend. The review noted that having overweight or obesity actually serves as the biggest risk factor for youth to develop type 2 diabetes, highlighting weight loss and prevention of weight gain as strategies to combat eventual disease development.

Indeed, as the number of overweight and obese children has increased, so too has the number of type 2 diabetes cases in younger people. Early diabetes development means affected young people may start experiencing complications associated with diabetes at an earlier age as well.

What Happens When Young People Develop Type 2 Diabetes?


Younger diabetes diagnosis and the potential for complications at an earlier age speak to the heart of the looming public health problem.

An earlier type 2 diabetes diagnosis goes hand in hand with greater risk. Earlier development means longer exposure to the disease, and young people who develop type 2 diabetes may need treatments like insulin earlier in life. Evidence also exists hinting at early-onset type 2 diabetes as a more aggressive form of the disease.

Children and adolescents with type 2 diabetes face health issues similar to their adult counterparts, but may experience these complications starting at an earlier age, according to the review in Pediatrics. Cardiovascular complications, kidney issues, health problems that threaten the limbs — the list goes on. Even if the diabetes diagnosis doesn’t come during childhood or adolescence, kids who are overweight or obese are still at a higher risk to develop the disease eventually.

Research Highlights Promising Opportunities for Change

The news isn’t all bad, though. Consider a study by Bjerregaard et al published in the New England Journal of Medicine in 2018.

Acknowledging that children who have overweight are at an increased risk for type 2 diabetes in adulthood, the study looked at Danish men who had their weights and heights measured at 7 and 13 years old and then again in early adulthood, defined in the study as between the ages of 17 and 26. The researchers sought to determine if children who were overweight at a young age would continue to have an increased risk of developing adult type 2 diabetes if they no longer were overweight at puberty or later.

The study uncovered promising statistics. Men who maintained a normal weight in early adulthood after losing weight between 7 and 13 years old had a risk of type 2 diabetes similar to men who had normal weight at all ages. While men who lost weight between 13 years old and early adulthood had a higher diabetes risk than men who had never been overweight, the risk was still lower than in men who were overweight at all ages included in the study.

Reversing the Trend Starts At Home

Focusing on being overweight in puberty as an important factor ultimately increasing the risk of developing type 2 diabetes later in life, the New England Journal of Medicine study indicates just how important learning healthy habits at a young age can be.

Family factors — such as food available at home and food preferences of family members — can influence what kids eat, and these factors have been associated with rising obesity cases. On the flip side, if kids learn about healthy eating, positive nutritional choices, and exercising at home, those lessons can carry over into choices kids make beyond the walls of their home.

Being overweight or obese aren’t the only risk factors for developing type 2 diabetes, and a holistic, empowering approach to any weight loss recommendations for kids is certainly a must. Still, the clear link means it’s something kids and the adults in their lives should pay attention to. Type 2 diabetes comes with the potential for complications in childhood and beyond — and the risks only increase with earlier disease onset. Yes, the stakes are high, but research indicates the lasting, positive impact that changes to nutrition and activity can have

Overweight Kids…Trouble in Paradise

Overweight Kids…Trouble in Paradise

by | Jun 6, 2021 | NUTRITIONAL-HEALTH

This article is the first in a series at metabolism.com;  “Overweight Kids….Trouble in Paradise”.  

In the opener, we touch on many aspects of what can be a toxic tangle. In coming articles we plan to break out and do a deeper dive into each of the aspects presented. Subscribe to metabolism.com below to avoid missing the next article, “ Are Overweight Kids Destined for Diabetes?” 

 By Gary M Pepper, M.D.  

 Childhood obesity presents one of the most urgent public health issues in the United States today. The intimate interaction between parents and their children further complicates the problem. Parents shape the eating habits their children develop — but that also means parents can serve as important partners helping their children to make healthier nutritional choices. 

About one in three children in the United States are classified as overweight or obese, as Kumar and Kelly note in their review published in Mayo Clinic Proceedings in 2017. These authors point out the prevalence of obesity increases as children get older. A 2014 study published in The New England Journal of Medicine, following children from entry into kindergarten through the end of eighth grade, also found that the prevalence of obesity increased by the time kids reached eighth grade. This research showed more children who were overweight when they entered kindergarten became obese by age 14 years old as compared to their normal-weight kindergarten classmates, with the biggest increase in obesity occurring between first and third grades. 

 Technically speaking, obesity is defined as a body mass index (BMI) of 30 or greater https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi-m.htm.  Childhood obesity comes with other health issues that affect physical and mental health. As the prevalence of childhood obesity has increased, so too has the prevalence of health complications in childhood typically thought to afflict mostly adults. Unfortunately, childhood obesity also tracks into later years: A high percentage of adolescents with obesity continue to remain obese as adults. 

The Rise of Childhood Obesity: Complex Causes, Dangerous Combinations 

 While endocrine and genetic disorders can lead to obesity, most kids don’t have an underlying endocrine or single genetic cause for weight gain. The 2017 review published in Mayo Clinic Proceedings pinpoints a positive energy balance combined with genetic predisposition for weight gain as the most common cause of obesity for children. In other words, kids are taking in more calories through food than they are expending with physical activity. 

 Childhood obesity results from complex interactions of factors related to a child’s genetics, epigenetics, and environment along with ecological effects such as family, community, and school. The environmental factors that can lead to weight gain are also quite complex and include: 

  • Adverse life experiences. 
  • Depression. 
  • Parental and general culinary culture conditioning. 
  • Perinatal factors (such as birth size, catch-up growth, antibiotic use). 
  • Psychosocial and emotional distress. 
  • Stress. 
  • Increased caloric consumption, aggravated when specific food intake is resulting in a high sugar burden. 
  • Decreased caloric expenditure. 

 The last two factors form a dangerous intersection. Sweet snacks and beverages, fast foods, big portions, and high-glycemic foods all contribute to increased caloric consumption. Decreased caloric expenditure due to reduced physical activity and a trend toward sedentary activities (think: computers, phones, tablets, and televisions) is also on the rise. Together, more calories taken in and less caloric expenditure creates the positive energy balance spurring weight gain. 

 The current pandemic paints a dire picture. With fewer opportunities for activity and a marked increase in negative emotional triggers, today’s kids are facing a unique challenge. Children need support and guidance to make healthy choices perhaps more than ever before. 

Health Issues Associated With Childhood Obesity 

 Childhood obesity can have serious health implications, with complications manifesting both during adolescence and later in life. Related health issues include: 

Diabetes 

 Children with obesity run an increased risk of developing diabetes. Along with the challenges of managing diabetes itself comes the risk of additional acute and chronic complications. 

 Abundant research has shown an association between weight in adolescents and the development of diabetes in adulthood. In the past 20 years the incidence of obesity in children and the incidence of diabetes in adulthood has increased hand-in-hand. 

 A 2017 study by Meyers-Davis et al in The New England Journal of Medicine found the incidence of both type 1 and type 2 diabetes increased significantly among youths between 2002 and 2012. Type 1 diabetes — which usually develops before the age of 35 years and requires insulin treatment — is not necessarily associated with being overweight. Type 2 diabetes, on the other hand, is typically associated with onset after the age of 35 years and almost always has overweight as the major factor. 

 Despite the common assumption that type 1 diabetes is the “worse” of the two types of diabetes, a study by Constantino et al published in Diabetes Care in 2013 found that early-onset type 2 diabetes came with greater mortality, more complications, and more unfavorable cardiovascular disease risk factors than type 1. Early-onset type 2 diabetes can also create metabolic challenges that last a lifetime.  

Cardiovascular Complications 

 Weight in childhood can play into cardiovascular health later in life. Twig et al examined the association between body-mass index (BMI) in late adolescence and death from cardiovascular causes as adults, In 2016, their research paper in The New England Journal of Medicine, concludes that overweight and obesity at a young age was strongly associated with increased cardiovascular deaths in adulthood. A 2013 study in Diabetes Care also noted cardiovascular deaths drove the increased death rate associated with type 2 diabetes, with many deaths occurring right in the prime of life. 

 All in all, childhood obesity can lead to various cardiovascular complications, including: 

  • Heart disease. 
  • High blood pressure. 
  • Stroke. 
  • Sudden death
  • Cancer 

 Diabetes and being overweight have been associated with an increased risk of several cancers, both as individual causes and as intertwined factors. Pearson-Stuttard et al looked at the incidence of cancers (such as liver and endometrial cancers) that could be attributed to diabetes and high BMI in a 2018 study in The Lancet Diabetes & Endocrinology. The study found many cancer cases linked to the prevalence of both. Though the combined effects are striking, the research also indicated that high BMI alone was responsible for twice the number of cancer cases caused by diabetes itself. 

Other Health Issues in Childhood and Beyond 

 Kids (and even parents) might think about many of the above risks as “adult” problems. However, childhood obesity is not just about a risk of death many years in the future. Kids can start experiencing the effects of obesity as young adults — or even earlier. 

 For example, a study by He et al in Fertility and Sterility published in 2018 investigated the association between childhood obesity and infertility in women. The research noted that childhood obesity appeared to increase the risk of infertility for women of reproductive age. 

 The 2017 review in Mayo Clinic Proceedings also listed a range of systems in the body that can be impacted by obesity during childhood, including: 

  • Dermatological. 
  • Endocrine. 
  • Gastrointestinal. 
  • Musculoskeletal. 
  • Neurologic. 
  • Pulmonary. 

 As noted in that review, childhood obesity can have psychosocial consequences as well. Children with obesity are more likely than their peers to experience bullying and discrimination, and they may contend with anxiety, depression, and poor self-esteem. 

What Can Parents Do Today? 

 The 2017 review from the Mayo Clinic underscores family-based lifestyle interventions as a cornerstone of weight management for kids. This approach is twofold, incorporating dietary modifications and increased physical activity. 

 Parents can guide kids learning to make healthier choices for their meals and snacks while encouraging unstructured physical activity (like playing outdoors) for younger kids and more structured physical activity (such as after-school sports) for older kids. At the same time, parents should limit screen time for tasks other than schoolwork — the Mayo Clinic recommends less than two hours of screen time per day for kids older than 2 years old and avoiding screen time altogether for kids younger than 2. 

 That’s easier said than done, of course. In the current pandemic reality, finding opportunities to turn off the screens and get outside are harder to come by than ever before. Even in the best of times, financial and cultural barriers to healthy eating and physical activity still exist. We’ll explore how parents can empower kids to change their dietary and activity habits later in this series. 

 Obesity can impact just about every part of the body, and obesity in childhood can have serious implications for years to come. Parents can play a big role in getting their kids motivated to change their eating habits. By offering a compassionate, nonjudgmental source of support, parents can give their kids the tools they need to make healthy and sustainable changes. 

 Metabolism.com and Dr. Gary Pepper wish to acknowledge and thank Farryl Last for her expert assistance in the preparation of this article,  

 

 References

  1. Seema Kumar, MD, Aaron S. Kelly, PhD. Review of Childhood Obesity: From Epidemiology, Etiology, and Comorbidities to Clinical Assessment and Treatment. Mayo Clinic Proceedings 2017;92(2):251-265. 
  2.  Solveig A. Cunningham, Ph.D., Michael R. Kramer, Ph.D., K.M. Venkat Narayan, M.D. Incidence of Childhood Obesity in the United States. The New England Journal of Medicine 2014;370:403-411. 
  3.  Elizabeth J. Mayer-Davis, Ph.D., Jean M. Lawrence, Sc.D., M.P.H., M.S.S.A., Dana Dabelea, M.D., Ph.D., Jasmin Divers, Ph.D., Scott Isom, M.S., Lawrence Dolan, M.D, Giuseppina Imperatore, M.D., Ph.D., Barbara Linder, M.D., Ph.D., Santica Marcovina, Ph.D., Sc.D., David J. Pettitt, M.D., Catherine Pihoker, M.D., Sharon Saydah, Ph.D., M.H.S., Lynne Wagenknecht, Dr.P.H. Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002–2012. The New England Journal of Medicine 2017; 376:1419-1429. 
  4.  Maria I. Constantino, Lynda Molyneaux, R.N, Franziska Limacher-Gisler, Abdulghani Al-Saeed, M.D., Connie Luo, R.N., Ted Wu, M.D., Ph.D., Stephen M. Twigg, M.D., Ph.D., Dennis K. Yue, M.D., Ph.D., Jencia Wong, M.D., Ph.D. Long-Term Complications and Mortality in Young-Onset Diabetes. Diabetes Care 2013; 36(12): 3863-3869. 
  5.  Gilad Twig, M.D., Ph.D., Gal Yaniv, M.D., Ph.D., Hagai Levine, M.D., M.P.H., Adi Leiba, M.D., M.H.A., Nehama Goldberger, M.Sc., Estela Derazne, M.Sc., Dana Ben-Ami Shor, M.D., Dorit Tzur, M.B.A., Arnon Afek, M.D., M.H.A., Ari Shamiss, M.D., M.P.H., Ziona Haklai, M.A., Jeremy D. Kark, M.D., Ph.D. Body-Mass Index in 2.3 Million Adolescents and Cardiovascular Death in Adulthood. The New England Journal of Medicine 2016; 374:2430-2440. 
  6.  Jonathan Pearson-Stuttard, B.M.B.Ch., Bin Zhou, M.Sc., Vasilis Kontis, Ph.D., James Bentham, Ph.D., Marc J Gunter, Ph.D., Majid Ezzati, F.Med. Sci. Worldwide burden of cancer attributable to diabetes and high body-mass index: a comparative risk assessment. The Lancet 2018; 6(6): e6-e15. 
  7.  Ye He, Ph.D. , Jing Tian, Ph.D. , Wendy H. Oddy, Ph.D. , Terence Dwyer, M.D., Alison J. Venn, Ph.D. Association of childhood obesity with female infertility in adulthood: a 25-year follow-up study. Fertility and Sterility 2018; 110(4)P596-604.e1. 
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