Diabetes and Obesity in Children

We are all aware of the great increase in type 2 diabetes in adolescents, but did you know that most parents don’t even think their children are overweight.

Parents of fully half the obese children in a recent study failed to recognize their child's obesity, and nearly three quarters did not see their child's obesity as a problem.

In the face of rising rates of childhood obesity and diabetes in the US, it is important that parents recognize their child's obesity, understand the health hazards associated with it, and seek treatment to restore a healthy weight.

Only a minority of parents of obese children had been told by their physician that the child was overweight, according to the results, although this information did increase the accuracy of the parent's assessment of their child.

More than 70% of the parents of overweight children said that their child's weight was not a health problem, However, parents who did correctly identify their child as overweight were more likely to recognize the health hazards of obesity.

How to help obese children and adolescents to exercise and lose weight, and help prevent the onset of Diabetes.

Obesity in children and adolescents is one of the most difficult conditions to treat. Unfortunately, very few studies of this problem have been reported, so the recommendations in the published literature are primarily the result of expert opinion. The recommendations of Barlow and Dietz^[1] remain the cornerstone for clinical guidance at this time. Dr. Tomoki Okuyama and colleagues^[2] of the Medical College of Georgia in Augusta are studying the impact of increased physical activity outside of school time; Dr. Tom Robinson and colleagues^[3,4] of Stanford University School of Medicine have been examining the relationship between television watching, ethnicity, and socioeconomic status and obesity, providing guidelines for both clinicians and parents.

Clinicians must keep in mind that obesity represents a chronic disease that requires frequent visits, continuous monitoring, and reinforcement for success. Clinicians must therefore be patient when working with obese children and their parents. An important first step is to correctly classify obesity in this population, using current growth charts and body mass index (BMI) assessment. Up to age 7, only those children above the 95th percentile for BMI who also exhibit disease-related complications such as hypertension, dyslipidemia, and insulin resistance should be given weight loss guidelines. The goal for all others in this age group is weight maintenance, ie, no weight gain. Over age 7, more aggressive weight loss goals can be established. Patients with disease-related complications and those in the 85th to 95th percentile should receive weight loss goals; patients without complications should be given weight loss goals if they are above the 95th percentile.

Experts agree that treatment of the obese child or adolescent MUST involve the family and all caregivers -- they must attempt to follow the eating behavior changes and to follow the exercise routine. Such environmental changes are essential to long-term success. All family members must monitor eating and activity patterns daily. Problems related to eating outside the home, lack of time allocated to activity, and the safety of activity environments can be detected using food and activity logs.

After reviewing the literature, the opinion is that the biggest gains are made through changes in activity patterns rather than through the institution of specific diets. Obese children or adolescents will likely be uncomfortable participating in organized sports activities. But they can be encouraged to be more active, by walking, biking, or just moving around, particularly after restrictions are placed on the amount of time the family can spend watching television. Children who include activity in their daily routine outside of organized activities are more likely to remain active. With regard to diet, unsupervised eating times, such as after school, can be curtailed by carefully monitoring the types of foods available in the home, as well as the amount of discretionary money the child is given to spend on snacks. Guidelines aimed at decreasing overall caloric intake by changing eating habits are preferred over "calorie counting" regimens.

Clinicians should recommend small gradual changes in eating and activity patterns. Begin with 2 or 3 suggested changes and add others only after the child and family have mastered these. Brief, frequent visits, up to once every 2 weeks, allow the clinician to assess the patient's progress, evaluate the appropriateness of the recommendations, measure body weight, and provide ongoing encouragement to both the child and the parents.

Information for this article came from:

Dr. Jennifer L. Bass, from the Albert Einstein College of Medicine in New York, at the Pediatric Academic Societies Annual Meeting in Baltimore May 1st.

Ann M. Coulston, MS, RD Nutrition Consultant, Stanford University School of Medicine, Stanford, California, via Medscape Inc.

Barlow SE, Dietz WH. Obesity evaluation and treatment: Expert Committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services. Pediatrics. 1998;102:E29.

Okuyama T, Owens S, Barbeau P, Riggs S, Bauman M, Gutin B. Relationships of diet and physical activity to total body adiposity in obese youth [abstract]. Med Sci Sports Exerc. 1999;31:S318.

Robinson TN. Reducing children's television viewing to prevent obesity: a randomized controlled trial. JAMA. 1999;282:1561-1567.

Robinson TN, Chang JY, Haydel KF, Killen JD. Overweight concerns and body dissatisfaction among third-grade children: the impacts of ethnicity and socioeconomic status. J Pediatr. 2001;138:181-187.