December 2000 • Volume 6 Number 12
Today's obese child -- tomorrow's diabetic patient?
BY CINDY McCANSE
It's bad enough that clinical obesity's on the rise among all Americans, jumping from about 15 percent to nearly 23 percent in the past two decades.
But even more alarming, according to researchers, is its growing prevalence among U.S. children and adolescents. During that same period, the prevalence of obesity in kids and teens nearly doubled -- prompting concern that rates of associated co-morbidities such as hypertension, hyperlipidemia and type 2 diabetes would also rise among these groups as they have among adults.
Fears borne out
Raul Zimmerman, M.D.
"Kids don't do their own cooking. You have to be working with the entire family."On one front, at least, those fears appear to have been borne out. Although data are limited, there is growing evidence that cases of type 2 diabetes (traditionally known as "adult-onset diabetes") are on the rise among patients ages 10 to 19.
Not surprisingly, this trend is most marked in patient groups that have an abnormally high prevalence of diabetes across all ages. Members of the Pima Tribe of Arizona represent such a group.
Three decades of research by the National Institute of Diabetes and Digestive and Kidney Diseases helped establish the link between obesity and diabetes in this population. Fully 50 percent of adult tribe members have diabetes; of those with the disease, 95 percent are overweight or obese.
More to the point, a 1992-1996 analysis of this ethnic group found the prevalence of type 2 diabetes to be 22.3 per 1,000 persons among 10- to 14-year-olds and 50.9 per 1,000 among 15- to 19-year-olds.
In addition, a retrospective study of 10- to 19-year-old patients in Cincinnati found that among African-Americans and whites, the incidence of type 2 diabetes leapt from 0.7 per 100,000 in 1982 to 7.2 per 100,000 in 1994. That's a huge increase for a disease that until very recently represented only 1 percent or 2 percent of all cases of diabetes in this age group. Researchers now estimate that between 8 percent and 45 percent of all youths newly diagnosed with diabetes have type 2 diabetes.
Screen youngsters
Obesity is a common thread throughout these diabetes case studies, making careful screening of overweight youngsters a priority, says FP Raul Zimmerman, M.D., co-director of the weight management program at Halifax Medical Center in Daytona Beach, Fla.
Even so, he says, diabetes may not manifest itself early on. "If you check obese patients for certain metabolic features like insulin sensitivity early enough in life, you'll probably find that they're normal. But if you continue to follow them over time, comparing their levels with those in non-obese people, you're more likely to see development of diabetes."
Part of the problem in detecting and managing diabetes in children and teens has been the lack of widely accepted diagnostic criteria.
Another obstacle is finding ways to treat the disease once it's found, Zimmerman says. For adults, that often means losing the weight -- even modest losses can translate into significant gains in glycemic control. But for kids, special problems can intrude.
"The group effort in weight management seems to be very important," he says. "You put obese adults together who are 30 or 40 years apart in age, and they do quite well. But you put a bunch of kids together -- even if they're only three or four years apart -- and they look at each other and say, 'You're not at all like me.' That's not a support group."
Encouraging increased physical activity can be a big challenge if the kids would rather watch TV or play computer games. Another hurdle: promoting healthy eating. "Kids don't do their own cooking," Zimmerman points out. "So from that perspective, you have to be working with the entire family" -- a situation often complicated by the fact that most heavy kids have heavy parents.
Add to that the paucity of antidiabetic medications available for young patients, and it's small wonder that policy-makers the world over are envisioning spiraling health care costs associated with obesity and its complications.
Clearly, early intervention is the key, says Zimmerman. Children at risk for obesity and its attendant health risks must be identified at a young age, and measures must be taken to head off potential complications. Early detection, patient education, caring intervention -- they're all tasks tailor-made for the family physician.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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