World is currently facing a twin epidemic of obesity and type 2 diabetes in young people

The global rise in obesity and type 2 diabetes in children and adolescents has led to an urgent call for action by the International Diabetes Federation (IDF).

IDF warns that the world is currently facing a twin epidemic of obesity and type 2 diabetes in young people. The Federation has outlined the problem and provided a set of responses in a consensus statement published this week in the international journal Diabetes Care.

The rise in obesity and type 2 diabetes – of which obesity is one of the major risk factors - in children and adolescents has led to a call to governments and policy makers to address the issue immediately. The problem is now so serious that IDF advocates lifestyle changes as well as treatment with medication.

“However, this is not just an issue for individuals”, said Professor Pierre Lefèbvre, President of IDF. “It also reflects the adverse effects on health of the reduction of both work and leisure physical activity in an increasingly urbanized world. It is an issue comparable to global warming and environmental pollution and requires major structural changes in society”.

The Childhood Obesity Epidemic: Already 1 in 3 Americans born today is predicted to develop type 2 diabetes as a consequence of overweight and obesity. Diabetes currently affects nearly 200 million people worldwide and IDF figures predict that this will increase to over 330 million by 2025, with a massive burden in developing countries. Worldwide, the number of people with diabetes has tripled since 1985.

A major feature has been the earlier age of onset of type 2 diabetes. Until the mid-1980s type 2 diabetes was considered as a disease of the middle-aged and elderly, developed after years of poor diet and lack of exercise. These same causes have led to a rise in the disease in children and adolescents as young as five.

The problem is particularly noticeable in indigenous peoples but affects all nations. Black and Mexican-American children in the USA and indigenous children in Australia are at a significantly higher risk of both obesity and type 2 diabetes. Between 8 and 45% of newly diagnosed children and adolescents in the USA have type 2 diabetes.

“While type 1 diabetes is currently the most frequent form in children, it is quite likely that type 2 diabetes will be the predominant form within 10 years in high-risk communities, many of which are in developing nations”, said Professor Sir George Alberti, Co-chairman of the IDF Consensus Working Group on Type 2 Diabetes in Children and Adolescents².

Professor Paul Zimmet, also Co-chairman of the Consensus Working Group, added: “This scenario gives a grim forecast for the next generation. We predict earlier deaths and disability from the health consequences of both excess weight and diabetes. The diabetes process can begin in foetal life, with low birth weight and poor nutrition. Combined with sedentary lifestyle and dietary factors in early childhood, the process results in type 2 diabetes which may lead to accelerated kidney and heart disease in early adulthood.”

Prevention Strategies: The IDF report notes that while the emphasis should be on lifestyle changes there is also a need to address the problem with medication.

Professor Martin Silink, President-Elect of the IDF, and also a member of the committee said: “Because of the sudden rise in type 2 diabetes in the young, there are as yet no approved drugs for treatment - apart from insulin and metformin. In addition, children and adolescents often require medical interventions for high blood pressure and cholesterol levels. They face a life-long need for medication and their risk of developing diabetes complications is equal to those with type 1 diabetes”.

School based programmes have been shown to be effective in Mexico and Singapore. Major governmental actions that focus on lifestyle are required too. The IDF report recommends that priority be given to:

• Assessing the costs and psycho-social impact of screening young people
• Assessing the safety and efficacy of oral hypoglycaemic drugs in young people
• Developing innovative ways of working with children and adolescents with diabetes and their families so as to achieve longstanding and sustainable lifestyle change.

According to Professor Lefèbvre, prevention programmes should focus on the prevention of obesity by encouraging and facilitating physical activity and healthy diets, and controlling access to energy dense foods and drinks.

“In particular for children, policies and legislation need to ensure safe play outdoors, safe transport to and from school by foot and bicycle, and protection from highly influential advertising which promotes inappropriate (and unnecessary) consumption of energy dense food and drink,” he added.