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Curr Diab Rep. Author manuscript; available in PMC 2015 Aug 1.
Published in final edited form as:
PMCID: PMC4099943
NIHMSID: NIHMS604408
PMID: 24919749
Department of Pediatrics, 1601 NW 12th Ave., University of Miami Miller School of Medicine, Miami, FL 33136.
305.243.6857 [email protected]
Correspondence to: Alan M. Delamater, PhD Department of Pediatrics University of Miami Miller School of Medicine [email protected]
The publisher''s weight and height and the score is then compared to an age and gender percentile-based norms to determine weight status. The Center for Disease Control uses the 85%ile and 95%ile as the cutoffs for classifying a child as overweight and obese, respectively.

Epidemiology

Recent estimates from the National Health and Nutrition Examination Survey indicate that approximately one-third of children in the United States are overweight or obese, with approximately 17% meeting criteria for obesity [1**]. Worldwide, approximately 43 million preschool-aged children have been estimated to be overweight and obese, and 92 million are considered to be at risk of overweight [2]. Children from African American and Hispanic cultures are at an increased risk for being overweight or obese [3]. A recent national longitudinal study in the US indicated that 12.4% of children in kindergarten were obese and another 14.9% overweight; overweight 5-year-olds were four times more likely than normal weight children to become obese later in childhood at age 14, and among children who later became obese, half were overweight at baseline and three-quarters were above the 75th %ile for BMI [4**].

Comorbidities

Children who are obese are at a significantly elevated risk for adverse health outcomes including both medical and psychological problems [5]. The most common medical co-morbidities associated with obesity include metabolic risk factors for T2D including high blood pressure, high cholesterol, impaired glucose tolerance, and metabolic syndrome [6,7]. Orthopedic problems, sleep apnea, asthma, dental problems, and fatty liver disease are also common comorbidities of obese children and adolescents. Behavioral factors have significant effects on metabolic risk. Research has shown that youth who do not meet guidelines for dietary behavior, physical activity and sedentary behavior have greater insulin resistance than those who do meet guidelines [8].

Psychosocial correlates of obesity include internalizing and externalizing disorders, ADHD, problems related to body image, reduced quality of life, low self-esteem, social isolation and discrimination [5,9*,10]. Depressed mood has been associated with greater risk of obesity and higher BMI [11]. The short and long-term medical and psychosocial effects of childhood obesity have adverse consequences including increased morbidities and early mortality in adulthood [12]. A prospective study of obese adolescents revealed that as young adults, women particularly had an increased risk of social and economic difficulties [13].

Etiology

Obesity has been attributed to various factors including genetics, environment, metabolism, behavior, personal history of obesity, culture, and SES [9*]. The origins of obesity can be traced to early adiposity rebound, which refers to the time at which young children''s weight status [23]. In one study of 812 school-aged children, parenting behaviors and parental BMI were stronger predictors of children''s home to fast food restaurants has been associated with increased obesity rates [26].

reverses diabetes type 2 januvia (πŸ‘ patho) | reverses diabetes type 2 glucose rangehow to reverses diabetes type 2 for Consumption of healthy food and energy expenditure in the form of physical activity are imperative to maintaining healthy weight. Results from the 2011 Youth Risk Behavioral Survey conducted in the United States indicated that among high school students nationwide, 22.5% reported eating fruit or drinking 100% fruit juices three or more times a day or more, and only 15.3% reported eating vegetables three or more times per day in the past week. During an average school day, nearly one-third (31.1%) reported playing video or computer games for 3 or more hours and about 50% reported not engaging in 60 minutes of physical activity 5 days a week in the last week [27]. One study reported that 40% of children between the ages of 1 and 5 years old had a television set in their room and the odds ratio of being overweight was 1.06 for each additional hour per day of television or videos seen [28]. Another study estimated that children of parents who are obese watch about 30 minutes more of television per day [29].

Cultural Factors

reverses diabetes type 2 treatment side effect (πŸ”΄ daily menu) | reverses diabetes type 2 diet ukhow to reverses diabetes type 2 for Increased risk for obesity among ethnic minority children may be explained in part by behavioral factors. Research with Mexican-American children, for example, has shown they have greater body fat, lower physical fitness and more sedentary lifestyle; in addition their diet is more likely to be unhealthy, including a greater percentage of calories from fat and saturated fat, and less consumption of fruits and vegetables [30]. Another study with Mexican-American children demonstrated early risk factors for metabolic syndrome, including high levels of body mass index, insulin, glucose, triglycerides, and systolic blood pressure, as well as lower HDL cholesterol [31]. Research with African-American children has demonstrated greater risk for T2D, with lower insulin sensitivity and higher insulin secretion than white children, after controlling for body mass index and/or visceral fat accumulation [32].

Differences in physical activity and sedentary behavior help explain ethnic and socioeconomic disparities in obesity rates of children. Research findings indicate ethnic minority children have higher rates of sedentary activity and get less physical activity than white children students in the United States [33, 34]. Living in low-income neighborhoods has also been associated with more sedentary behavior and less physical activity [35]. School environments affect physical activity in youth, as research has shown children in high socioeconomic (SES) schools have more regular physical education classes than children attending low SES schools [36]. The evidence therefore indicates that environmental factors associated with urban and low-income neighborhoods increases the likelihood of low rates of physical activity among minority and low SES children.

Recent research on disparities in physical activity has focused on the “built environment,” including neighborhood characteristics such as amount of green space, degree of urbanization, residential/commercial land use, and transportation systems [37]. Ethnic minority youth have less access to safe facilities in their neighborhoods in which to be physically active [38]. Low SES neighborhoods often lack sidewalks and are unsafe, factors that are associated with higher rates of obesity [39].

There are also many barriers to a healthy diet for low SES and ethnic minority youth. For example, research has documented that youth living in low SES neighborhoods have less access to supermarkets providing fresh fruits and vegetables, high fiber bread, and low fat milk [35]. Convenience stores or bodegas in these environments are more often utilized by families, providing foods which have higher concentrations of sodium, fat, and processing. With fewer supermarkets, not surprisingly there are more fast food restaurants concentrated in low income neighborhoods that have more ethnic minority children [40].

Treatment

The U.S. Preventative Services Task Force (USPSTF) recommended in 2010 that children be screened for obesity by the age of six years and if they meet criteria they should be offered moderate to intense (25 hours or more) diet, physical activity, and behavioral childhood obesity treatments [41**]. However, given the fact that obesity in children at the age of five years predicts later obesity [4**], screening and treatment for obesity should occur even earlier in childhood. There are a number of approaches for the treatment of overweight children, including family-based behavioral lifestyle intervention, internet-delivered interventions, residential interventions, medical interventions, and school-based interventions.

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Family-based behavioral interventions have been shown to be efficacious for overweight children, with significant weight loss maintained even ten years after treatment [9*, 42]. Family-based interventions for weight management include nutrition and physical activity education, self-monitoring of dietary intake and physical activity, goal-setting, stimulus control techniques, and training parents in behavior modification for children''s obesity status through screening programs which are generally well received [62]. A large number of controlled studies have shown school-based interventions to have some success in improving children''s, very few children with diabetes (about 1-2%) were classified as having T2D. However, as obesity has increased in recent years, the incidence of T2D has increased to 25-45% of all youth diagnosed with diabetes [73,74]. In studies published in the late 1990''s, depending on their level of glycemic control [87**].

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In general, research has shown less healthy lifestyle behaviors among overweight and obese youth than their normal weight peers, with more sedentary behavior, less physical activity, and poorer dietary habits. Although there is less research on lifestyle behaviors of youth with T2D, the available findings indicate a similar pattern. An early report showed no regular physical activity, low fiber intake and high dietary fat intake among adolescents with T2D and their family members [88]. A more recent study of adolescents with T2D found they frequently overate, drank sweetened beverages, ate fast food, and had high rates of physical inactivity [89]. Another report found that youth with T2D, compared with age and BMI-matched youth without diabetes, had lower levels of cardiorespiratory fitness and less physical activity [90]. Similarly, a report from the TODAY study group found that youth with T2D were significantly more sedentary than obese youth from the NHANES cohort [91].

Treatment

The major goal of treatment is to achieve normoglycemia. To achieve this, daily oral medication (metformin) and sometimes insulin is prescribed [67**], along with daily monitoring of blood glucose, as well as other daily medications to treat various comorbidities.. Metformin, an insulin sensitizer, was shown to significantly improve glycemic control in the 1 last update 04 Aug 2020 youth with T2D [92]. Metformin and insulin are the only medications currently approved for use in youth with T2D, although a number of other medications are being considered [93*]. More controlled studies are needed for the selection and initiation of specific oral medications and insulin [67**, 94].The major goal of treatment is to achieve normoglycemia. To achieve this, daily oral medication (metformin) and sometimes insulin is prescribed [67**], along with daily monitoring of blood glucose, as well as other daily medications to treat various comorbidities.. Metformin, an insulin sensitizer, was shown to significantly improve glycemic control in youth with T2D [92]. Metformin and insulin are the only medications currently approved for use in youth with T2D, although a number of other medications are being considered [93*]. More controlled studies are needed for the selection and initiation of specific oral medications and insulin [67**, 94].

A key issue in treatment is patient and family education to improve medication adherence and lifestyle modification in order to reduce obesity [94]. However, management of T2D is clearly challenging for clinicians. In a survey of physicians caring for youth with T2D, several problems were noted, including high risk behavioral lifestyles, behavioral and psychological problems, decreased motivation for self-care, and cultural barriers [95]. Because most youth with T2DM are overweight, it is essential for them to lose weight by focusing on improving dietary intake, increasing physical activity, and decreasing sedentary behaviors. Because family influences are so important for children''s diabetes management: while parents acknowledged the opportunity to provide support and serve as positive role models, they also reported difficulty in setting a good example for healthy lifestyle behaviors [100]. Having family members with T2D may impact negatively on youth through family acceptance of diabetes-related health complications. When older family members have experienced impaired health due to chronic hyperglycemia such as retinopathy, nephropathy, limb amputations, and premature death, youth may perceive these complications as an inevitable course of diabetes [101]. Parental involvement was found to be a significant correlate of glycemic control in a study of 75 youth with T2D that used a measure of family responsibilities for T2D. Results showed that youth with poor glycemic control had parents who were less involved for social and proactive care of diabetes [102].

Adherence Issues

reverses diabetes type 2 diet plan (⭐️ reddit) | reverses diabetes type 2 qualify for fmlahow to reverses diabetes type 2 for There are some developmental, physical, and psychosocial features that differentiate T2D from type 1 diabetes and other chronic health conditions, and these factors may contribute to high rates of regimen non-adherence among youth with T2D. Youth with type 1 diabetes may suffer aversive consequences related to hypoglycemia and hyperglycemia if they are non-adherent. However, if youth with T2D do not take their medications or check their blood glucose, they may not experience such consequences. This perception of lack of connection between adherence and health outcomes may contribute to the high rates of non-adherence often reported in adolescents with T2D.

For example, several reports described the high rates of non-adherence to for 1 last update 04 Aug 2020 medical treatment and diet and exercise prescriptions among adolescents with T2D, noting that many patients fail to lose weight, have poor glycemic control, or drop out of treatment [103, 104, 105]. A few longitudinal studies of youth with T2D reported low follow-up rates. In a study of German and Austrian adolescents, 60% dropped out of care after a mean of 7.1 months [106], and in a study of black youth in New York, 39% of patients dropped out of medical follow-up by 2 years and 78% after 5 years [107].For example, several reports described the high rates of non-adherence to medical treatment and diet and exercise prescriptions among adolescents with T2D, noting that many patients fail to lose weight, have poor glycemic control, or drop out of treatment [103, 104, 105]. A few longitudinal studies of youth with T2D reported low follow-up rates. In a study of German and Austrian adolescents, 60% dropped out of care after a mean of 7.1 months [106], and in a study of black youth in New York, 39% of patients dropped out of medical follow-up by 2 years and 78% after 5 years [107].

T2D is usually diagnosed in early adolescence, which is a time when youth become more autonomous from their parents; thus youth with T2DM may be expected to manage their self-care tasks more independently. Furthermore, the unhealthy lifestyle habits that lead to obesity and T2D are already well established by the time of diagnosis. Parents can be responsible for physical activity and feeding of their young children, but adolescents typically have more autonomy and must be more responsible to engage in appropriate self-care behaviors on their own. In addition, for many adolescents, peer acceptance is a major issue and they may be reticent to engage in self-care behaviors that make them look different. Consequently, they may not want to check their blood glucose, eat differently, or take medication in front of their peers. The issue of non-adherence in adolescents with chronic disease can also be understood because of lack of cognitive maturity, in that most adolescents do not relate unhealthy behaviors with negative health outcomes [108].

Several qualitative studies have addressed these issues. In one study, parents reported that typical adolescent behavior such as the need for immediate gratification, affected diabetes management behaviors [100]. They also identified other factors making diabetes management difficult, including peer influences, limited awareness of long-term consequences of diabetes, family conflict, and deception. Another study examined how accurate adolescents with T2D and their parents were with regard to their overweight status [109]. Both parents and the adolescents underestimated the severity of weight issues: only 41% of parents and 35% of adolescents accurately perceived the adolescent to be overweight, while 87% were actually obese. Inaccurate perception about weight was associated with less physical activity and poorer dietary habits in the adolescents.

Adolescents’ perspectives on self-management of T2D were examined in two qualitative studies. In one study, 10 African American girls were given structured interviews to identify resources and barriers for self-management [110]. Results indicated they viewed mothers and peers as sources of support, but acknowledged health comorbidities, negative peer influences, dietary and regimen challenges, and financial difficulties as barriers to effective care of T2D. Focus groups were conducted with 24 adolescents (mostly African American) with T2D in another study [111]. A number of barriers were identified including social (embarrassment, fear of rejection from peers), family (others in family who have unhealthy lifestyles or health problems from T2D), psychological (denial of health risks, not being concerned about missing medication doses, lack of normalcy), and environmental (dietary challenges at school and restaurants) barriers.

Psychological Problems

There are relatively few published studies addressing the role of psychological problems in youth with T2D. One study found that at the time of diagnosis, 20% had a pre-existing psychiatric disorder, including attention deficit disorder, depression, bipolar disorder, and schizophrenia [112]. A report from the SEARCH study found that youth with T2D, particularly boys, were significantly more likely to report depressed mood than youth with type 1 diabetes [113]. In fact, compared to boys with type 1 diabetes, boys with T2D were 3.5 times more likely to report significantly depressed mood. Twenty percent of girls and 18% of boys with T2D reported symptoms of moderate to severe depression in this study. Furthermore, poor glycemic control and more frequent emergency department visits were associated with depressed mood. A report from the TODAY study group found that 15% of youth with T2D reported significant depression, with older girls reporting more depression and depressed mood associated with lower quality of life [114]. In another report from the TODAY study group, 20% of youth reported subclinical and 6% reported clinically significant binge eating; binge eating was associated with greater obesity, more depression, and lower quality of life [115]. Reduced quality of life in youth with T2D has also been reported [116].

Conclusions

Over the past several decades there has been a striking increase in the rate of overweight and obesity in children in the U.S, as well as in many countries throughout the world. Although the etiology of this phenomenon is multi-factorial, behavioral and environmental influences play significant roles. Similarly, rates of T2D have increased dramatically along with the rising incidence of obesity, and obesity is prominent in most cases of youth diagnosed with T2D. Children from lower income families and of ethnic minority backgrounds are at increased risk for both obesity and T2D. Obese children evidence increased metabolic risk factors, and those with a family history of T2D appear to be at greatest risk for development of T2D. Both obesity and T2D confer increased risk for development of various health disorders, contributing to the probability of decreased life expectancy. In addition, obesity and T2D in youth is associated with increased risk for psychological problems such as depression, eating disorders, and reduced quality of life, and are accompanied by unhealthy dietary and physical activity lifestyle behaviors.

Obesity and T2D thereby represent very significant public health issues in terms of both adverse personal impacts on health and costs to society through increased health care utilization over time. Efficacious treatments are available for obese children, but a major issue is how to reach the population of overweight and obese children. In-person clinical interventions involving family-based behavioral programs may be effective, but most families needing treatment for their children are unlikely to receive comprehensive evidence-based treatment programs. Internet-based programs have had some success with weight loss and maintenance and have potential for increasing the reach of effective intervention to the population. In the 1 last update 04 Aug 2020 cases of morbid obesity, inpatient and surgical approaches have been used but additional research is needed to demonstrate their safety and long-term effects. Some weight loss medications have been evaluated, but more work is needed in this area. Identification and treatment of overweight children in the school setting has some promise, as do obesity prevention programs delivered to children at school. Because treatment of obesity is only modestly effective, obesity prevention beginning in early childhood is a priority area for future research; public health and policy approaches offer promise in this regard.Obesity and T2D thereby represent very significant public health issues in terms of both adverse personal impacts on health and costs to society through increased health care utilization over time. Efficacious treatments are available for obese children, but a major issue is how to reach the population of overweight and obese children. In-person clinical interventions involving family-based behavioral programs may be effective, but most families needing treatment for their children are unlikely to receive comprehensive evidence-based treatment programs. Internet-based programs have had some success with weight loss and maintenance and have potential for increasing the reach of effective intervention to the population. In cases of morbid obesity, inpatient and surgical approaches have been used but additional research is needed to demonstrate their safety and long-term effects. Some weight loss medications have been evaluated, but more work is needed in this area. Identification and treatment of overweight children in the school setting has some promise, as do obesity prevention programs delivered to children at school. Because treatment of obesity is only modestly effective, obesity prevention beginning in early childhood is a priority area for future research; public health and policy approaches offer promise in this regard.

The diagnosis of T2D in children and adolescence has increased significantly in the past two decades in the U.S. and is also increasing in prevalence throughout the world, particularly among certain ethnic minority populations. Research indicates that youth with T2D are likely to develop serious diabetes-related health complications relatively early in adulthood, contributing to decreased life expectancy. Even in youth with T2D, early signs of microvascular and macrovascular health complications may be present. Family history of T2D in very common among youth with T2D, and research suggests family factors are significant influences on youths’ T2D management. For example, family members with high risk behavioral lifestyles may not provide good models for healthy dietary intake and physical activity. Not surprisingly, youth with T2D are likely to have unhealthy dietary and physical activity lifestyle habits.

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Given the fact that youth with T2D are at high risk for development of diabetes-related health complications, identification of effective medical and behavioral treatment approaches remains a priority. More research is needed better understand how psychological and psychosocial factors affect regimen adherence, including medication taking and blood glucose monitoring, as well as weight loss efforts, attendance at follow-up outpatient visits, as well as glycemic control. More studies should also address the treatment of psychological disorders in order to improve diabetes management and quality of life.

Given the substantial health risks associated with poor control of T2D in youth, programs should screen high-risk children, including overweight, ethnic minority youth with a family history of T2D. Evidence-based weight control treatments that may reduce T2D risk should focus on these high-risk children. Research focusing on the prevention of T2D in children and adolescents continues to be a high priority for public health.

Acknowledgment

The authors are grateful for the assistance provided by Maria Toro, B.A., in the preparation of the 1 last update 04 Aug 2020 this manuscript.The authors are grateful for the assistance provided by Maria Toro, B.A., in the preparation of this manuscript.

Footnotes

Compliance with Ethics Guidelines

Conflict of Interest

Elizabeth R. Pulgaron and Alan M. Delamater declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest have been highlighted as:

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