Diabetes Continues to Rise in Young Patients

Obesity rates among children have tripled during the past 20 years, according to data from the National Health and Nutrition Examination Survey published in 2002. Research has shown that increased rates of obesity have led to higher rates of type 2 diabetes. About one in six overweight adolescents have pre-diabetes, according to the American Diabetes Association. Reports and studies suggest type 2 diabetes among children and adolescents -- while still relatively rare -- is being diagnosed more frequently, says the ADA.

These are sobering statistics about the current obesity epidemic in America and its connection to children and diabetes. Physicians who have been seeing more cases of type 2 diabetes among their younger patients in recent years must address the underlying obesity factor with those patients.

“The most effective thing we can do as physicians is to promote a healthy lifestyle” among younger patients, says family physician Kevin Peterson, M.D., M.P.H., of Minneapolis.

When it comes to children and obesity, short behavioral interventions are not effective, says Peterson, who chairs the National Diabetes Education Program’s Heath Care Provider Work Group and is an associate professor in the department of family medicine and community health at the University of Minnesota Medical School in Minneapolis.

He recommends a more intensive intervention, such as that proposed by the U.S. Preventive Services Task Force, which includes components of counseling and behavioral therapies combined with possible pharmacotherapy. "Intense interventions can be twice as effective as any medication we could prescribe" as monotherapy, says Peterson.

Getting family members involved also is key to a successful intervention. Peterson says that he usually starts with a group discussion that includes the parents and a dietician.

That type of group support can be important, says Peterson. In addition, he notes, “It is important to involve (children), because they’ll often take a lot of responsibility for themselves.”

But when designing an intervention for an obese child there is no need to completely reinvent the wheel, says Peterson. Many things learned from tobacco or alcohol interventions can be applied to obesity interventions.

“One of the most important measures we found from tobacco interventions is to be in close contact with patients,” Peterson says. “Telephone calls are very effective in keeping patients motivated for a behavioral change.”

He agrees with recommendations from the Institute of Medicine and other health groups that children spend less than two hours daily in front of the television or computer. Because extended periods of inactivity can contribute to weight gain, some doctors are incorporating a media profile in their pediatric evaluations by asking questions about how much time a patient spends watching television or on the computer.

However, television and the Internet are easy scapegoats. Peterson notes that a lot of a child’s unhealthy eating habits and inactivity may be learned from his or her parents. If parents aren’t eating healthy and exercising, their children likely won’t be either.

“A lot of parents will want their kids to live a healthier lifestyle than they do,” Peterson says. “It’s important that children get exercise every day. I wish there were easy answers or pills, but exercise is the only thing that can prevent this.”

Although there are no hard data on why American obesity has ballooned in the past generation, Peterson points to highly processed carbohydrates as a major culprit. “ (Highly processed carbohydrates) taste great, are easy to eat and get absorbed into the body quickly -- so the kids get hungry and eat more,” Peterson says.

The ease of transportation these days also causes problems. “We have easy access to go places," says Peterson. "The car is parked only a few feet away in the garage,” so children don't have to be active to be mobile.