Type 2 diabetes in youth

Issue: BCMJ, vol. 52, No. 8, October 2010, Page 385 Editorials

Until recently, type 2 diabetes mellitus was almost unheard of in children, but over the past few years there has been a significant increase in incidence of this condition in children and adolescents. It has occurred too rapidly to be solely attributable to genetic predisposition, indicating that environmental factors are likely to play a key role in its development. 

The hallmark of type 2 diabetes is insulin resistance and the most common cause of this is overweight and obesity (overweight is defined by a body mass index of 25 to 29.9 or waist circumference of >80 cm in females and >94 cm in males and obesity as a BMI >30 or waist circumference of >88 cm in females and >102 cm in males). 

About 50% of the Canadian population is overweight or obese. The proportion of obese children has almost tripled in the last 25 years in both females and males in all age groups except preschoolers. Children of obese parents have a 66% risk of being obese before adulthood. 

It is estimated that 26% of Canadians age 2 to 17 (more than 1 in 4) are overweight or obese, up from 15% in 1978. Ninety-five percent of children with type 2 diabetes are obese. 

With the seemingly unabated in­crease in prevalence of obesity, type 2 diabetes in youth is emerging as a serious public health concern. It is associated with increases in morbidity and mortality from both microvascular and macrovascular disease, and we are now seeing these complications, particularly coronary artery disease, appearing in young adults.
This childhood obesity epidemic means that today’s children will become the first generation in some time to potentially have a shorter life expectancy than their parents!

Currently, the economic costs re­lated to obesity and its consequences are not insignificant but relatively small. Without effective intervention, though, they may well become staggering in the future.

Preventing childhood obesity in the first place is obviously the goal and comes down to a need for comprehensive changes in dietary and lifestyle habits. This is a very complex issue and intervention must take place at a number of levels—the family, schools and community, the food and entertainment industry, policymakers, and government agencies.

The fast food industry in particular needs to get on side and make radical changes. For the most part, unfortunately, they offer “bad” foods. Bad foods are cheap, heavily promoted, and engineered to taste good. They are loaded with calories, sugars or refined carbohydrate, fat, and salt. Portion sizes have exploded.
“Supersized” portions of fries, burgers, and pop are typically two to five times larger than when first introduced. Some fast food chains have introduced healthier meals, but they are generally more expensive than the standard burger and fries.

Regular physical activity is key to achieving and maintaining a healthy weight. It’s recommended that children get at least 60 minutes of physical activity daily, and sadly this is often not achieved. 

On a positive note, the ActNowBC initiative has led the way in recognizing the importance of preventing obesity and promoting health. It was es­ta­blished in 2005 as a cross-government health promotion initiative and their mandate involved achieving five goals by 2010. Three of these related to healthier food and exercise habits and resulted in new guidelines for food and beverage sales in public schools in BC. 

These were developed with registered dietitians and implemented in 2008. New recommendations for physical activity in schools were also introduced in 2008. Their web sites and links for parents and families trying to adopt a healthier lifestyle are excellent tools.

There is promise that we can begin to stem the tide of childhood obesity, but it will take a massive shift in our current habits. Little steps can start at home!

Susan E. Haigh, MD. Type 2 diabetes in youth. BCMJ, Vol. 52, No. 8, October, 2010, Page(s) 385 - Editorials.

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