Obesity and Type Diabetes in Children

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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. Overweight or obesity is present in as many as 25 percent of all children. Only a fraction of these children go on to develop diabetes.

There are a number of conditions that 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:

1 Lower respect from peers than other disabled children get 1 Less comfortable family interactions 1 Poor body image 1 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 (see Chapter 7). A child is obese or overweight if his BMI is at the 95th percentile or greater for his age and sex. He is at risk for overweight if the BMI is between the 85th and 95th percentile. The growth charts that indicate the percentiles for BMI can be found at: www.brightfutures.org/ bf2/pdf/pdf/GrowthCharts.pdf.

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

i Metabolic syndrome, discussed in Chapter 5, leading to an increased tendency for heart attacks and strokes i Polycystic ovarian syndrome, also discussed in Chapter 5, leading to infertility, abnormal menstrual periods and hairiness in girls i Heart disease due to the increased work of the heart i High blood pressure, which can damage the heart and the kidneys i Sleep disorders like obstructive sleep apnea with snoring and increased blood pressure i Fatty liver with abnormal liver enzymes in the blood i Gallbladder disease i Bone and joint diseases due to the weight on the bones i Skin abnormalities like acanthosis nigricans, black velvety patches on the joints and under the arms i 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. There are a number of things that you can do to prevent obesity in your child:

i Try to have a normal weight before you become pregnant. i Exercise throughout your pregnancy. i Breast feed for at least three months. i Eat meals together as a family. i Avoid sugary drinks and fatty foods.

i Restrict time for sedentary activities like TV or computers. i Eliminate fundraisers that sell candy and cookies. i Insist on exercise daily and do it with your child.

Dealing with type 2 diabetes

Adding type 2 diabetes into this mix 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.

It is important to separate type 1 diabetes from type 2 because the child with type 2 diabetes has a milder condition and can be treated with pills or diet and exercise alone. However, because children do not appreciate long-term consequences of their actions, you often have the problem of compliance.

fiEH 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.

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

1 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.

1 Drugs: The currently available drugs are either not recommended for children under 16 years of age or not useful for long-term treatment.

1 Surgery: Children with extreme obesity with BMIs of 35 and greater may require bypass surgery or gastric banding. This has been successful but has complications like infection, deficiency of certain nutrients like vitamins and calcium, pneumonia and hernia. It should be used especially in children with other risk factors like a strong family history of heart disease, sleep apnea or high blood pressure. This surgery should only be performed in medical centers with large experience in children.

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