More than one-third of American children and adolescents are overweight or obese, putting them at risk for a host of health issues, including metabolic disorders and cardiovascular disease. Many of those diseases may not manifest until adulthood, but increasingly physicians are seeing one disease in individuals under age 20—Type 2 diabetes mellitus.
Type 2 diabetes used to be rare in young adults, let alone children. In recent years, however, the burgeoning number of children and adolescents with the disorder has risen to alarming proportions. In 2012, approximately 208,000 teens and young children had Type 2 diabetes. Even more were prediabetic or at high risk of developing diabetes based on blood glucose levels.1
Children in certain ethnic or racial groups have particularly high risk of developing diabetes if they are overweight. These include African Americans, American Indians, Hispanic/Latino Americans, and some Asian and Pacific Islander Americans.
In Type 2 diabetes, the pancreas continues to produce insulin, but cells become more resistant to it. The disease is strongly associated with excess weight and lack of physical activity. More than 80% of Type 2 diabetics under the age of 20 are overweight and 40% meet the criteria for obesity.
The good news is that Type 2 diabetes and prediabetes can be reversed or their complications minimized in many cases by losing weight and increasing physical exercise. Losing just 7% of body weight can make a significant difference in the long-term risk associated with diabetes.
The CDC recommends that children with diabetes follow a healthy meal plan developed by a registered dietitian, diabetes educator or physician. The meal plan should balance the nutritional needs of a growing body with calorie consumption that reduces or prevents obesity and keeps blood glucose levels in the desired range.
A healthy meal plan does not mean a crash diet or deprivation. Successful weight loss and healthy weight maintenance requires changing eating patterns for life. To do that, teens need to develop an understanding of why, when and how they choose certain foods. Do they open a bag of potato chips when they come home from school? If they are told, for instance, to eat grapes instead, they may do it for a while, but if stressed — an exam is coming up, they had a fight with a parent — they will reach for that bag of chips again in many cases. To keep choosing the grapes or other healthy habits, they first need to understand and recognize the habitual patterns they engage in (like reaching for potato chips when stressed). They need to get mindful about what they are doing and why and how those choices will affect them in the short and long term. They also need to make sure they have less energy dense, more nutritionally balanced options on hand.
A combination of nutrition lessons and therapy help make the lessons of healthy eating stick and contribute to sustained weight loss. Understanding that whole fruit has more fiber and less impact on blood glucose levels makes it easier for a teenager to choose an orange over orange juice. Realizing that white rice will spike their blood sugar much more than quinoa or brown rice can help them make better choices at dinner — and feel better all evening.
Cognitive behavioral therapy and dialectical-behavioral informed therapy provide essential support to adolescents who are just coming to terms with the consequences of their own behaviors. Their prefrontal cortex is still not fully developed, which makes it hard for them to resist immediate gratification in favor of long term objectives. Therapy helps them step back and ask, “Is this in line with the goals I’ve set for myself?” The therapy keeps them on track even if they make the occasional poor choice because they create a foundation of self-acceptance that coexists with a desire to change and improve. They no longer get derailed by one bad decision. For diabetic teenagers, the therapy can also enable them to accept greater responsibility for their disease management, teach them how to take care of themselves in social situations, and cope with the stress associated with a chronic disease.
Therapy can also help overweight teens develop more positive attitudes toward exercise. The target for all children is 60 minutes of exercise every day. Exercise not only contributes to weight loss, it makes muscle cells more sensitive to insulin. A counselor or trained coach can support an adolescent in the search for enjoyable activities and help them see regular movement as an important part of daily life. The key is to find an activity or activities that are fun and keep them in balance so that that the teenagers do not injure themselves or burn out on one sport and never pick another type of exercise.
With some directed help from clinical and exercise professionals, the risk for Type 2 diabetes can be mitigated, or sometimes even reversed.
Overview of Diabetes in Children and Adolescents. National Diabetes Education Program. July 2014