Preventing and Treating Obesity and Type 2 Diabetes in Children

By Alan L. Rubin

The epidemic of obesity, which has spread to children in the United States in the past few decades, has led to a much higher prevalence of type 2 diabetes in children than was ever seen before. As many as one-third of all US children are overweight or obese. However, only a fraction of these children go on to develop diabetes.

A number of medical conditions can cause obesity in children, but they represent probably 1 percent of the causes. Most of them can be diagnosed during the course of a good physical examination by your child’s pediatrician. By far, the major reason for obesity in children is too many calories in and too few burned up by exercise.

Even without diabetes, obesity is a burden for children. The obese child faces severe psychological and social consequences:

  • Lower respect from peers than other disabled children get

  • Less comfortable family interactions

  • Poor body image

  • Low self-esteem

Defining obesity in children

The definition of obesity in children age 2 to 19 is based on the body-mass index, BMI. A child is obese or overweight if his BMI is at the 95th percentile or greater for his age and sex. He is overweight if the BMI is between the 85th and 95th percentile. You can find the growth charts that indicate the percentiles for BMI at Bright Futures.

Obesity is not just responsible for type 2 diabetes. It can also provoke a number of other dangerous medical conditions in children. These include

  • Metabolic syndrome leading to an increased tendency for heart attacks and strokes

  • Polycystic ovarian syndrome leading to infertility, abnormal menstrual periods, and hairiness in girls

  • Heart disease due to the increased work of the heart

  • High blood pressure, which can damage the heart and the kidneys

  • Sleep disorders like obstructive sleep apnea with snoring and increased blood pressure

  • Fatty liver with abnormal liver enzymes in the blood

  • Gallbladder disease

  • Bone and joint diseases due to the weight on the bones

  • Skin abnormalities like acanthosis nigricans, black velvety patches on the joints and under the arms

  • Nervous-system diseases such as increased pressure in the brain with headache and visual disturbances

Preventing obesity in children

Prevention of obesity is much preferred over treating the damage that it does. You can do the following things to prevent obesity in your child:

  • Try to have a normal weight before you become pregnant.

  • Exercise throughout your pregnancy.

  • Breastfeed for at least six months. A study in Diabetes Care in March 2011 showed that it reduces the occurrence of obesity in your child and reduces the increased obesity in your child associated with exposure to your diabetes while in the uterus.

  • Eat meals together as a family.

  • Avoid sugary drinks and fatty foods.

  • Restrict time for sedentary activities like TV or computers. Adolescent boys with screen time of two hours or more daily have twice the risk of insulin resistance compared to boys with less than two hours.

  • Don’t allow your child to participate in fundraisers that sell candy and cookies.

  • Insist on exercise daily and do it with your child.

Changes are coming in schools. New federal guidelines set calorie caps on meals in school, gradually reduce the amount of salt in school foods, eliminate trans fats from school food, and reduce the amount of fat in milk and other foods. Food companies are reformulating foods that they sell to schools to meet these guidelines.

The outlook for children with type 2 diabetes is much worse than type 1 diabetes with much earlier death due to heart disease, on average just 27 years after the diagnosis is made. The incidence of high blood pressure and kidney disease including kidney failure also rises rapidly. Treatment must be improved.

Dealing with type 2 diabetes in children

Adding type 2 diabetes to obesity can be devastating. The consequences of the preceding problems may lead to failure to manage the diabetes because the child wants to avoid any activity that makes him or her even more different from his or her peers.

You must help your obese child to lose weight because most obese children become obese adults. With the assistance of a dietitian, you can figure out the food that your child can eat to maintain growth and development without gaining more weight. One of the most helpful techniques is to take the child into the supermarket and point out the difference between empty calories and nourishing calories. Another is never to make high-calorie food, such as cake and candy, a reward. Finally, if you keep problem foods out of the house, there is much less likelihood that your child will eat them.

When type 2 diabetes develops, treatment should begin as early as possible to minimize the development of complications. Depending on the severity of the diabetes, the treatment can utilize any or all of the following approaches:

  • Lifestyle changes: Parents must set an example of good dietary and exercise habits. Some studies suggest that if parents go first, children will follow. The best diet is one that emphasizes a variety of vegetables, some fruits, and small amounts of protein with minimal processed carbohydrates like candy and pastries. The best exercise is what you will continue to do regularly.

  • Drugs: The currently available drugs, with the exception of metformin, are either not recommended for children under 16 years of age or not useful for long-term treatment. A study in the New England Journal of Medicine in June 2012 showed that adding rosiglitazone to metformin increased the number of children in control of their diabetes, so the addition of other drugs may be changing.

  • Surgery: All of the information about metabolic surgery for diabetes in adults pertains to children, although it’s important that they have attained maturity of their skeleton, which is usually age 13 for girls and 15 for boys. The presence of depression or an eating disorder doesn’t preclude surgery. Weight-loss surgery is safe for adolescents, but they tend to have low adherence to vitamin supplementation after surgery, which must be addressed.

Because it’s reversible, adjustable gastric banding is probably the operation of choice in children. Experience with 110 teenagers who had this surgery at the New York University Program for Surgical Weight Loss showed an average 55 percent weight loss with no complications or deaths.

The International Pediatric Endosurgery Group has published bariatric surgery recommendations for children and adolescents. Essentially, the recommendations exclude children who have not attained final or near-final adult height. The BMI must be greater than 40 kg/m2 or greater than 35 kg/m2 if other diseases such as diabetes or heart disease are present. A trial of lifestyle change has been unsuccessful. The family unit should have a psychological evaluation and be stable. The surgeon should be experienced and have a team that can do long-term follow-up. The adolescent will adhere to healthy dietary and exercise habits after surgery.

Surgery in preadolescents or in people planning to become pregnant within two years isn’t recommended.