Childhood Obesity: Following in Dangerous Footsteps

According to the Centers for Disease Control and Prevention (CDC), more than one-third (34.9%, or 78.6 million) of US adults are obese.¹ Obesity is not unique to the adult population, however. Also according to the CDC, childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years.²

According to an article in The American Journal of Surgery, “Starting from a base body mass index (BMI) of 21, the risk of developing type 2 diabetes is 5 times greater at BMI 25, 35 times greater at BMI 30, and 93 times greater at or above BMI 35.”³

Connection to Type 2 Diabetes

Diabetes, once an adult-onset disease, is fast becoming more evident in the pediatric population.⁴ According to a position statement released by the American Diabetes Association, “In the last decade, the incidence and prevalence of type 2 diabetes in adolescents has increased dramatically, especially in ethnic populations.”⁵ A position statement published in Diabetes Care by the American Diabetes Association states, “There are about 215,000 individuals younger than 20 years of age with diabetes in the United States.”⁶

How do these numbers continue to grow at what seems to be at an exponential rate? What has changed over the last several years? The obesity epidemic plays a large role in the insulin resistance involved in prediabetes and type 2 diabetes (T2D).⁷ Because the T2D epidemic parallels the obesity epidemic, this article focuses on both conditions, collectively known as diabesity.³

Risk Factors for Obesity

As health care professionals, we know there is a link between obesity, genetic susceptibility, and environmental factors (Figure). Environmental factors include socioeconomic status, sedentary lifestyle, and accessibility to inexpensive, high-fat foods.⁸ Because the risk for obesity is due to shared genes and environmental factors within the family,⁹ having a parent who is obese can significantly alter the risk of developing obesity in adulthood, especially in children younger than 10 years. This symbiotic relationship holds true for both obese and nonobese children.

Maternal obesity can have a negative impact on a child’s health in many ways, as well. Infants born to heavier mothers and women diagnosed with gestational diabetes have a higher risk of being overweight later in life and developing diabetes in adulthood.¹⁰

According to data from the Healthy Prevention Study Group-Primary Prevention Trial sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases, the risk of developing T2D begins early in life. Therefore, in order to decrease the prevalence of T2D throughout the age spectrum, interventions to reduce risk factors should occur as early as possible. Also, because the T2D epidemic parallels the obesity epidemic, the benefits of early intervention should hold true for decreasing the development of obesity.⁷

In addition to genetic susceptibility, several lifestyle factors play a role in the development of T2D and, therefore, are the primary focus for the prevention of obesity and T2D. These lifestyle factors include^7,11:

• Sedentary lifestyle: less physical activity, more TV/video games/computer time
• Larger portion sizes
• Sugary foods and drinks
• Convenient and cheap fast food

A lack of understanding of obesity as a disease can also have a negative impact on patient outcomes. Many patients may not understand this health condition and how to manage it or may be unaware that implementing certain lifestyle changes can significantly improve their outcomes. In addition, children exposed to foods high in fat and sugar, with little or no exercise to compensate, may become accustomed to this lifestyle, which may influence the cycle of obesity within families.

Prevention

Obesity can easily be diagnosed, yet there has been inadequate progress in preventing the obesity crisis. Early recognition, in addition to prompt and early intervention, is essential to prevent obesity from developing. Focusing efforts at preventing obesity in children and adolescents, as well as managing obesity in these populations, is critical. In addition, focusing “on obesity in girls and young women with childbearing potential, where obesity does double damage” is of the utmost importance.⁸

Solutions: Breaking the Cycle

• Education is essential to help patients and their families understand their condition, the associated risks, ways to reduce their risks, and proper management. The entire family must make an effort to change the lifestyle factors that may increase the risk for obesity. Parents are encouraged to model these efforts for all family members and to not single out the family member(s) with obesity.¹¹
• Increase access to healthy, affordable food.
• Provide healthier foods (including in vending machines) and appropriate portions at schools.
• Implement lifestyle modifications, such as healthy eating and increasing physical activity, which are critical strategies for weight loss. Lifestyle changes that result in weight loss of 3% to 5% of initial body weight can provide clinically positive health benefits.¹² In addition, intensive lifestyle modification programs can significantly reduce the rate of diabetes onset; research has shown about a 58% reduction after 3 years.¹³
• Early detection and diagnostics. To combat the diabesity epidemic, strategies have to be put in place to properly screen and identify high-risk individuals.¹⁴

Endnote

Obesity is a multifaceted disease that requires a multifaceted approach. Society needs to put forth an effort.¹⁵ Since there is an increase in prevalence of obesity in children, a different approach, however, must be used for them. In children, the focus should be on preventing obesity in childhood and implementing effective approaches to manage children who are overweight.⁹ Furthermore, additional efforts are needed to determine effective approaches for combating the obesity crisis.¹⁵

Dr. Garza received her doctor of pharmacy degree from the University of Texas at Austin. She is currently working as the director of the Life Sciences Library at RxWiki, where she continues to build her practice on the fundamental belief that providing patients with medication information and medical knowledge contributes significantly to the quality of care they receive and improves quality of life and health outcomes. Her work focuses on educating patients and providing them with the resources needed to navigate the overwhelming and complex health system. Before RxWiki, she was director of pharmacy for a Central Texas Department of Aging and Disability facility.

References

• Overweight and obesity: adult obesity facts. Centers for Disease Control and Prevention website. www.cdc.gov/obesity/data/adult.html. Updated September 9, 2014. Accessed March 15, 2015.
• Adolescent and school health: childhood obesity facts. Centers for Disease Control and Prevention website. www.cdc.gov/healthyyouth/obesity/facts.htm. Updated December 11, 2014. Accessed March 15, 2015.
• O’Brien PE, Dixon JB. The extent of the problem of obesity. Am J Surg. 2002;184(6B):4S-8S.
• Hu F. Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care. 2011;34(6):1249-1257. doi: 10.2337/dc11-0442.
• American Diabetes Association. Classification and diagnosis of diabetes. Sec. 2. In Standards of Medical Care in Diabetes 2015. Diabetes Care 2015;38(Suppl. 1):S8—S16.
• American Diabetes Association. Diabetes Care in the School and Day Care Setting. Diabetes Care. 2014;37(Suppl 1):S91-S96.
• National Institutes of Health. The HEALTHY study; Prevention Study Group Primary Prevention Trial Protocol. NIDDK. 2008:1-68.
• Kral JG. Preventing and treating obesity in girls and young women to curb the epidemic. Obes Res. 2004;12(10):1539-1546.
• Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting besity in young adulthood from childhood and parental obesity. N Engl J Med. 1997;337(13):869-873.
• Herring S, Oken E. Obesity and diabetes in mothers and their children: can we stop the intergenerational cycle? Curr Diab Rep. 2011;11(1): 20-27. doi: 10.1007/s11892-010-0156-9.
• Hansen J, Fulop M, Hunter M. Type 2 diabetes mellitus in youth: a growing challenge. Clinical Diabetes. 2000;18(2):52-60.
• Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline forthe management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity /Society. J Am Coll Cardiol. 2014;63(25):2985-3023. doi: 10.1016/j.jacc.2013.11.004.
• American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2015;38(1):S1-S90.
• Annis AM, Caulder MS, Cook ML, Duquette D. Family history, diabetes, and other demographic and risk factors among participants of the National Health and Nutrition Examination Survey 1999-2002. Prev Chronic Dis. 2005;2(2):A19.
• Rodgers GP, Collins FS. The next generation of obesity research: no time to waste. JAMA. 2012;308(11):1095-1096.