As concern about children’s health grows along with their waistlines, experts at C.S. Mott Children's Hospital warn that the childhood

How will the epidemic of childhood obesity today affect the future health of Americans?

As concern about children’s health grows along with their waistlines, medical experts fear that the childhood obesity epidemic could lead to large numbers of younger adults developing type 2 diabetes, causing serious and lasting health complications for future generations of Americans.

In an article in the July issue of the Archives of Pediatric & Adolescent Medicine, University of Michigan C.S. Mott Children’s Hospital pediatric endocrinologist Joyce Lee, M.D., M.P.H, warns that the most damaging effects of childhood obesity have yet to surface, and will likely result in an epidemic of type 2 diabetes among young adults, leading to a greater number of diabetes complications, and ultimately, lower life expectancy.

“The full impact of the childhood obesity epidemic has yet to be seen because it can take up to 10 years or longer for obese individuals to develop type 2 diabetes,” says Lee, a member of the Child Health Evaluation and Research (CHEAR) Unit at Mott. “Children who are obese today are more likely to develop type 2 diabetes as young adults.”

The longer a person has type 2 diabetes, Lee says, the more likely he or she is to develop devastating complications. Young adults with type 2 diabetes are therefore more likely to develop complications such as blindness and kidney failure during their lifetimes, and they have higher rates of type 2 diabetes complications and heart disease than older adults with type 2 diabetes.

Plus, babies born to young women with type 2 diabetes are at greater risk for obesity and type 2 diabetes, creating a vicious cycle.

“Recent studies suggest that there have been dramatic increases in type 2 diabetes among individuals in their 20s and 30s, whereas it used to be that individuals developed type 2 diabetes in their late 50s or 60s, “ notes Lee, assistant professor in the Department of Pediatrics and Communicable Diseases at the U-M Medical School. “This may be the first indication of a type 2 diabetes epidemic among young adults who were obese during childhood.”

Given the delayed negative effects of childhood obesity, Lee says that there needs to be a greater overall investment in childhood obesity, to prevent development of type 2 diabetes.

“Our society heavily invests in the treatment and management of chronic diseases like type 2 diabetes for adults. But it spends very little for the prevention and treatment of childhood obesity to stave off the onset of type 2 diabetes,” says Lee.

“If there isn’t a significant investment in obesity prevention and treatment during childhood within schools, communities, and the health care system, recent trends in childhood obesity will likely lead to increases in type 2 diabetes among young adults, resulting in even greater costs to society and the health care system.”

Lee notes that further studies are needed to learn more about how trends in childhood obesity will impact future rates and age at onset of type 2 diabetes.

These studies will help assess the future burden of disease and disability in the population, and to evaluate whether interventions in childhood can successfully prevent individuals from developing type 2 diabetes over their lifetimes.

Funding: Lee’s work on this study was supported by the U-M Clinical Sciences Scholars Program.

Reference: Archives of Pediatric & Adolescent Medicine, July 2008, Vol. 162, No. 7.

About Type 2 Diabetes

Type 2 diabetes is also referred to as non-insulin dependent diabetes mellitus (NIDDM), or adult onset diabetes mellitus (AODM). Type 2 diabetes affects nearly 21 million in the United States and nearly 200 million people worldwide.

Type 2 diabetes is characterized by high levels of blood sugar, caused by the body's inability to utilize insulin to move blood sugar into the cells for energy. In type 2 diabetes, patients can still produce insulin, but do so relatively inadequately for their body's needs, particularly in the face of insulin resistance as discussed above. In many cases this actually means the pancreas produces larger than normal quantities of insulin.

Diabetes is a major cause of heart disease and stroke, as well as the most common cause of blindness, kidney failure and amputations in U.S. adults. 

About Obesity

Obesity is a condition in which the natural energy reserve, stored in the fatty tissue of humans and other mammals, exceeds healthy limits. It is commonly defined as a body mass index (BMI) (weight divided by height squared) of 30 kg/m² or higher.

Mortality is increased in obesity, with a BMI of over 32 being associated with a doubled risk of death.  Central obesity (male-type or waist-predominant obesity, characterized by a high waist-hip ratio), is an important risk factor for the metabolic syndrome, the clustering of a number of diseases and risk factors that heavily predispose for cardiovascular disease. These are diabetes mellitus, Type 2 diabetes mellitus, high blood pressure, high blood cholesterol, and triglyceride levels (combined hyperlipidemia).

Apart from the metabolic syndrome, obesity is also correlated with a variety of other complications. For some of these complaints, it has not been clearly established to what extent they are caused directly by obesity itself, or have some other cause (such as limited exercise) that causes obesity as well. The affected health conditons include but are not limited to:

• Cardiovascular: congestive heart failure, stroke, enlarged heart and its associated arrhythmias and dizziness, varicose veins, and pulmonary embolism
• Endocrine: type 2 diabetes mellitus, insulin resistance, polycystic ovarian syndrome (PCOS), menstrual disorders, and infertility
• Gastrointestinal: gastroesophageal reflux disease (GERD), fatty liver disease, cholelithiasishernia, and colorectal cancer
• Renal and genitourinary: erectile dysfunction, urinary incontinence, chronic renal failure, hypogonadism (male), breast cancer (female), uterine cancer (female), stillbirth
• Integument (skin and appendages): stretch marks, acanthosis nigricans, lymphedema, cellulitis, carbuncles, intertrigo
• Musculoskeletal: hyperuricemia (which predisposes to gout), immobility,joint pain, osteoarthritis, low back pain
• Neurologic: stroke, meralgia paresthetica, headache, carpal tunnel syndrome, dementia, idiopathic intracranial hypertension
• Respiratory: obstructive sleep apnea, obesity hypoventilation syndrome, asthma
• Psychological: Depression, low self esteem, body dysmorphic disorder, social stigmatization
• Erectile Dysfunction 

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