Children at Highest Risk from Obesity Struggle with Change

A new study shows that children with obesity-related diabetes are reporting serious difficulties in making basic lifestyle changes that could save them from a lifetime of complications.

The study of 103 adolescents (ages 12 to 21) with type 2 diabetes, most of whom are overweight, shows many children and teens do not possess good self-management behaviors. The study was conducted by the Vanderbilt Diabetes Research and Training Center, working with patients at the Vanderbilt Eskind Pediatric Diabetes Clinic.

The respondents reported that making basic lifestyle changes that will lead to better future health, in areas such as diet and exercise, is more difficult than adjusting to medical management of their disease. Medical management includes daily medicines, blood sugar monitoring and injections of insulin. The study’s findings are published in the April issue of the journal Pediatrics.

“Type 2 diabetes in children is such a new problem that we don’t know a lot about these kids,” said Russell Rothman, M.D., deputy director of the Prevention and Control Division of the Vanderbilt Diabetes Research and Training Center. “This study is one of the most comprehensive to date to look at who these kids are and the challenges they and their families face trying to take care of themselves.”

Rothman and Shelagh Mulvaney, Ph.D., assistant professor in the School of Nursing, along with physicians and nurses from the Eskind Pediatric Diabetes Clinic, performed the telephone survey. Most children were either overweight or obese (possessing a body mass index (BMI) over 85 percent of the average for their age and weight).

More children (37 percent) reported the most difficult part of managing their disease was changing health habits like diet and exercise; 31 percent perceived taking insulin to be the most difficult part; and 18 percent had the toughest time adjusting to finger sticks for blood sugar tests.

More than 80 percent of patients reported taking medication regularly, and nearly 60 percent monitored their glucose twice daily. However, about 70 percent reported watching at least two hours of TV each day, and 63 percent said they did not currently participate in physical education classes. Children reported that barriers to making changes were: dealing with cravings or temptations, feeling stressed or sad, and frequently eating outside the home.

The study also found racial disparities. African-American patients had worse blood sugar control and were slightly more likely to act like adolescent peers without diabetes—such as drinking sugary drinks and eating junk foods with regularity. The reasons for the disparities are not clear, and because this was not the target of the survey, this opens up the possibility for future surveys to better understand reasons for the disparities.

“These results indicate children are having a very difficult time now, and so you might think it would be very difficult to take care of themselves long-term,” Rothman said. “This will mean a major health crisis for the country to deal with later. We owe it to ourselves, as well as to these young patients, to find better ways to help them manage their obesity and diabetes.”