TYPE 2 DIABETES AND CHILDREN

Part 1:
Fred Pescatore, MD, MPH, CCN

It is my pleasure to have been asked back to write another series of articles for Diabetes in Control. The variety of professionals who read this newsletter is quite impressive, so it is truly an honor to write again. Since there are so many great contributors I thought long and hard about the topic I should choose. Unfortunately, I am going back to a topic that I wrote about in my book called, Feed Your Kids Well. This was my first book and still my favorite. I wrote that book over five years ago now when I noticed the frightening problem of obesity in our next generation. Unfortunately, at that time, no one heeded my call to be more vigilant with our dietary recommendations. Now, we have no choice.

More than 1 in 3 children are overweight and more than 1 in 4 are obese. And, worse yet, the rates of diabetes in these children are beginning to skyrocket. Not the type I normally found in kids, but type II, adult onset diabetes, now found in kids as young as 7 years old. Therefore, since most of this newsletter is dedicated to the problem of diabetes in adults, I thought I would discuss this issue in children. It is different to treat them, but not difficult at all. They are better at following instructions than most of my adult patients. Don’t be afraid to offer sound nutritional advice to them because they need help.

One of my worst fears came true the other day. I knew it was only a matter of time before this happened anyway – it is being recommended that children now be placed on cholesterol lowering medications. Since most overweight kids will have elevated cholesterols, be pre-diabetic at the very least, and absolutely need help in learning how to control their weight and food cravings, I’d like to spend the next few weeks helping you teach our next generation healthy habits now.

Youngsters care about being overweight. I know of one 6-year-old girl who, overly concerned about her weight (in truth, she was, at most, just a few pounds overweight,) put herself on what amounted to a starvation diet. She refused to eat any solid food at all, and would drink only juice, and that sparingly. Eventually, the situation became so serious that her parents needed to put her in the hospital, where she was fed intravenously. At the same time, she was put into counseling to help her deal with her skewered self-image. Finally, after months of therapy, she finally consented to eating solid food. Nevertheless, to this day she is exceedingly vigilant as to her weight. And remember, this is a mere six year old!

Adjusting Our Attitudes
Not long ago, a patient with a weight problem visited my office. As she removed her coat, she remarked casually, “My nephew was at a birthday party the other day and they served pizza, cake and ice cream. You know -- all the good stuff.” She paused a moment, then sighed with envy, “Isn’t it great that kids can get away with eating like that? I sure wish I could eat that way and not gain weight.”

This attitude toward children and food reveals a terrible misconception that has led to millions of American children being overweight. And perhaps even more importantly, these same children, their eating patterns established early in life, grow up to be adults who are constantly battling a “weight problem,” which inevitably dooms them to a lifelong struggle against obesity.
We are generally aware that the habits, values and disciplines we instill in our children will serve them throughout their lives. Yet, oddly enough most parents cling to the misguided notion that in terms of their eating habits, children are a species apart from the rest of the human race and that common sense rules and well-established laws of cause and effect do not apply.
There is an old maxim that goes, “Give me a child for the first seven years, and you may do what you like with him afterwards.” The seeds of what become our personalities, our likes, our dislikes, even our eating habits, are sown early. Show me the food intake of a child, and I will show you the dietary and health problems that child will have as an adult. We have to instill proper eating habits early.

In this country, we are faced with an obesity epidemic that unquestionably begins in childhood. Some nutrition experts have even gone so far as to call ours a “fat enabling” culture. Examples abound: the colossal buckets of buttered popcorn now standard at movie theaters; the half gallon of soda that has become an accepted serving size; the half-pound cinnamon bun served at every mall across America; the growing sizes of restaurant portions.

And let us not forget America’s fascination for and craving of anything advertised as “low-fat.” The truth is, in the long run, not only is low-fat unhealthy for your child, but the over-consumption of any processed food product is ultimately damaging to his or her health. During processing natural vitamins and minerals are taken out of the food and, at best, replaced with chemical versions which are not absorbable by the body and thus nutritionally useless and, at worst, not replaced at all. Food producers and purveyors, well aware of our weaknesses, continually expand the choices and availability of such foods, while advertisers, who especially prey upon impressionable children who tend to watch more television and attend more movies than adults, bombard us and our children with the not so subliminal message that it’s okay to eat large portions of food. Now, this same problem is being compounded by the low carb industry with their misguided notion of effective or net carbs vs. total carbs. A carbohydrate is a carbohydrate is a carbohydrate and most of them are absorbed by the body. Don’t be fooled into the next round of consumer fraud espoused by a food industry only interested in increasing their bottom line without regard for our and our kids waistlines.

The Perils of “Wonder Drugs”
By the age of 6, nearly 40% of American girls have expressed a desire to be thinner. By age 9, nearly 50% have dieted once and, by the age of 16, 45% will have put themselves on some kind of a crash diet. Even more disturbing is the fact that 15% take diet pills on a regular basis. Is this something you want for your child, to be addicted to prescription medications? I think not.
There have been countless stories in the popular media and many more in the medical journals about children who have lost their lives or have become addicted to medications in their quest for thinness.
The FDA has recently approved a diet drug for children that has not been shown to work on adults. Again, another desperate attempt by a pharmaceutical company to continue to have a patent and make lots of money. Kids on prescription drugs – the bane of the 21st century.
I think it’s the wrong message to instill in our next generation that there’s a pill for everything. Instead, we must instill a sense of responsibility for one’s action, even when it comes down to making the right decisions as to what to eat.

It’s Not Just Baby Fat!
“Train a child the way he should go; and when he is old he will not depart from it.”
--Proverbs XXII, 6.
Some people are appalled by the idea of regulating a child’s food intake. “He’s so young, why should I worry about what he eats now? He’ll outgrow it, won’t he?” Nothing could be further from the truth. More often than not children won’t outgrow it. The eating patterns they set as a child will stay with them for the rest of their lives. In fact, the older the child is, the greater risk there is that obesity will continue into adulthood.

Consider these facts, compiled by the National Research Council:
41% of obese 7-year olds become obese adults.
70% of obese 10-year olds become obese adults.

And this pattern continues through adolescence. More than 80% of obese adolescents remain obese as adults. I was one of the lucky ones as I was an overweight child and adolescent who has managed to significantly change my eating habits and stay slim, but the prognosis is not good for most children. The severity of the obesity also factors into whether the obesity continues into adulthood. For instance, for those 7-year olds who are 30% to 45% over their ideal weight, just half of these will be obese in adulthood. Among those same children who are 57% to 65% above their ideal weight, 80%, or 4 out of 5, will be obese adults. And for those 7-year olds who are over 65% of their ideal weight, virtually all will be obese.

It takes dedication and hard work to instill proper eating habits in your children. But, in the end, they will appreciate it...and so will you. I just wish my parents had proper information as to how they should have been feeding me and my sisters.

Children don’t have to be overweight. They can be taught early in life the proper way to eat. But until and unless parents understand the roots of their child’s eating problems start in childhood, their attempts at having their child lose weight are doomed to failure. By nature, parents want to give their children anything and everything to make them happy. But certainly this doesn’t include anything that’s bad for them, or will cause them discomfort, either now or in the future. For this reason, parents need to know what is good for their children to eat while making sure that it tastes good. At the same time, children need to know that making appropriate choices empowers them to do something positive about their weight.

Why are children in this country putting on so much excess weight? There are several reasons. For one thing, with the growing prevalence of the two-parent working household, or the one-parent family, many youngsters frequently eat their meals away from home, without the guidance of a parent. Unfortunately, far too often this translates into reliance on the nutritional wasteland of fast food, candy, cookies, potato chips, pretzels, and other empty calorie foods that can be easily grabbed on the run. Also, there is a growing trend in this country for families to eat different meals at the same mealtime depending on what the child likes. I don’t know about the rest of you, but if I didn’t eat what was put in front of me, I went to bed hungry.
Although parents may believe that the nutritional situation is vastly improved if a child gets lunch at school, this is not always the case. Recent studies have shown that excess consumption of fruit juice leads to an increase in childhood obesity. It has been found that the average school-age boy drinks the equivalent of nearly 3 cans of soda a day, with girls’ consumption close behind. They often get these beverages either in school, or as part of a school lunch.

Professionals in the field of dietary needs are certainly aware of the problem, and have tried to set guidelines. Unfortunately, they rarely work, primarily because most often they miss the mark. The National Cancer Institute has devised what they call “the five-a-day” program, which is designed to encourage people to eat five fruits and vegetables a day. Although this may be an optimistic figure, it is hoped that people will at least come close to this recommendation. Is this a realistic recommendation? Yes. Is this likely to happen considered the way most kids eat today? Not by a long shot.

So, where does this leave us? It leaves us with a generation of children who do not have proper eating habits, don’t really know what a home cooked meal is and are struggling with adult diseases. In our next segment, I am going to discuss the weight, metabolism and self-esteem issues behind some of the poor nutrition choices our children face.

Part 2 is Here

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