“We talk about our children being our future and our most important asset, but as a society, we don't always put our money where our mouth is. I think we are ignoring very large side effects of the pandemic when we don't talk about how this has impacted children's weights and associated conditions.”
Dr. Rachana Shah joins Shireen to explore the link between childhood obesity and type 2 diabetes. She outlines what to expect if your child experiences a pre-diabetes diagnosis, childhood obesity, and/or type 2 diabetes. Tune in to hear about what healthcare providers and caregivers can do to better prevent and manage childhood obesity and type 2 diabetes.
Dr. Shah is a pediatric endocrinologist and the medical director of the Healthy Weight Program at the Children's Hospital of Philadelphia. She has a special interest in pediatric obesity, type 2 diabetes, and other metabolic complications. She is also the mother of 2 young sons.
Shireen: In this episode, Dr. Rachana Shaw explores the link between childhood obesity and type two diabetes and what factors contribute to the two conditions. She outlines what to expect if your child experiences a pre-diabetes diagnosis, childhood obesity, and/or type two diabetes. Tune in to hear about what healthcare providers and caregivers can do to better prevent and manage childhood obesity and type two diabetes and recent developments in this space.
Podcasting from Dallas, Texas. I am Shireen and this is the Yumlish podcast. Yumlish is working to empower you, to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.
Shireen: Dr. Russia is a pediatric endocrinologist and the medical director of the healthy weight program at the Children's Hospital of Philadelphia. She has a special interest in pediatric obesity, type two diabetes and other metabolic conditions. She's also the mother of two young sons. Welcome Dr. Shaw.
Dr.Shah; Thank you for having me
Shireen: Absolutely! Diving right in, Dr.Shah, what drew you to become a pediatric endocrinologist?
Dr.Shah: I've always been fascinated by hormone systems and how they affect so many aspects of physical and mental health, which led me to endocrinology. I actually did a joint residency training in internal medicine or adult medicine and pediatrics, but realized I am passionate about prevention of disease processes at the earliest stage, which steered me to continue to work primarily in PDM.
Shireen: Interesting. What is the state of childhood obesity and type two diabetes in the United States currently?
Dr.Shah: So, the most recent CDC data is from 2018, which states that about 20% of all children are obese. Astonishingly. The rate is already 13% in two to year olds and certain ethnic groups, including Hispanic and black children 25% have obesity with numbers a little bit lower in white and Asian kids. In terms of diabetes, the overall rate it's 12 out of a hundred thousand children, but again, this rate is much higher in certain populations, including black, Hispanic, and native American children. And in obese children, the rate of diabetes is about 0.5 to 1% for teenagers that are obese.
Shireen: So I want to come back and talk about some of the reasons why it is so prevalent in people of color, but first I want to switch gears and quickly talk about how COVID 19 in particular impacted the state of obesity and type two diabetes.
Dr.Shah: In the unit. COVID has caused a surge in pediatric obesity due to lack of access to physical activity, increased time spent with screens and sitting, reduction of structure around food and meals and the impact of family stress.
Every day, I am seeing young children who have gained 40 to 50 pounds over one year, and all of us that are parents also understand, you know, how this has impacted our own family. For type two diabetes, we still don't have the overall incidence of diabetes during COVID, but most pediatric endocrinologists will tell you that they are seeing much higher rates of type two diabetes since the pandemic. At the American diabetes association conference this summer, there was a group that reported a three times higher rate of hospitalized patients with type two diabetes in 2020 compared to 2019.
As we continue to come out of this pandemic and children are being evaluated and tested. I suspect this increase will continue.
Shireen: And now to quickly touch upon the factors that are contributing to increased rates of childhood obesity and type two diabetes in the United States. Can you help us understand a little bit of that? And then specifically for what you reported out within ethnic groups? What, what exactly is going on?
Dr.Shah: Yeah. I mean, I think obesity is related to nature and nurture. So, you know, genetics, social determinants of health, the food environment, all of those play a role, Recent cultural shifts to a more sedentary lifestyle and increased reliance on processed foods, but tend to be higher in sugar and calories is certainly increasing weight gain and children.
And sadly, we noted that rates of pediatric type two diabetes and obesity are also much higher in certain minority populations. While genetics may play into this, we're also beginning to understand the effects of poverty, racism, and neighborhood rauma and other social factors on development of obesity and diabetes.
Shireen: Can you tell us more about what a pre-diabetes diagnosis means for children's health and how to potentially prevent type two diabetes?
Dr.Shah: First and foremost, I want to reiterate that pre-diabetes is reversible and does not mean that a child is destined to develop diabetes. It should, however, be traded as a wake up call that changes need to be made to prevent diabetes and other metabolic illnesses in the future.
Shireen: And how does obesity affect children and adolescents during their youth and even beyond?
Dr.Shah: So of course there are the medical risks of obesity: diabetes, high blood pressure, high cholesterol, fatty liver disorders, and menstrual functioning and girls and pubertal development, arthritis, other bone joint issues and sleep apnea.
We know that heart damage is already beginning in teens that are obese. But there are also psychosocial issues. Obese children have higher rates of depression, anxiety, and eating disorder. Many children are bullied about their weight when there is long-term stress from weight stigma in the population as well.
Shireen: If these children were to develop type two diabetes as well, how would that affect them?
Dr.Shah: As we are seeing now from the long-term today or treatment options for type two diabetes in youth study, the development of type two diabetes in childhood is associated with frighteningly early development of diabetes complications, such as heart disease, kidney failure, nerve, and I impaired.
Compared to non-diabetic children, they are also less likely to complete college and have less earning potential Type two diabetes has implications for life expectancy, fertility, pregnancy complications, and then passing on these effects to even their own children through addiction mechanisms.
Shireen: So help us understand how obesity and then childhood diabetes related. Is obesity the main cause of diabetes? Help us understand that a little better.
Dr.Shah: So obesity is a huge risk factor, but other factors are certainly at play because not all obese children develop diabetes. Certainly we know that genetics are a big factor, Patients that have multiple family members that develop type two diabetes are much higher at risk. If a child has additional medical problems or certain medications being used, those might also factor into diabetes development Often though obesity is the only risk factor that we can actually modify. We can't change our genes. We may not be able to change our medications and other medical problems. So the obesity and the weight is where you'll see most of the focus. When we're thinking about prevention,
Shireen: Dr.Shah, what role can healthcare providers like yourself really play in supporting children in preventing obesity and type two diabetes? All of these studies that are coming out are pointing to what I like to call “the slow pandemic,” right? Like it's, it's coming and it's, and it's sort of infiltrating our society. We're not even realizing because it creeps up in the dark, right? What role are we going to play? Systematically, what shifts are happening here that can help prevent this from turning into obesity and then even into type two diabetes”
Dr.Shah: So prevention is key and it's never too early. I think pediatricians and other organizations should be educating parents and children starting very early in life, perhaps even during a mother's pregnancy and certainly in the newborn and later periods, on healthy lifestyle habits that can prevent weight gain and associated complications.
It's a lot easier to have slowed down and stem obesity than it is to reverse it once it has already set in. And it's a lot easier to start with healthy habits than it is to make profound changes later, um, even in a child's life. And then if we are noticing weight gain that is beyond the norm, early referral to a nutritionist or a specialized pediatric weight management center, should be considered. A lot of times I think pediatricians or parents kind of wait until it becomes more dire before they think that they need help, and everybody needs help. And there is no, I think there should not be any stigma or shame in asking for help when you're noticing an issue with your child's weight or eating.
And then in terms of diabetes, again, you know, we should be screening for diabetes and children that are obese or have a strong family history of type two diabetes. And really again, educating the children and their families on what this means and how we can prevent it from going further.
Shireen: You mentioned something interesting with, you know, looking at it a little bit more upstream, even when the mother is pregnant, for instance. Can you tell me a little bit more about that and how that can have an implication on obesity sort of down the road for the child? What, what is that connection? Help me understand that.
Dr.Shah: So we know that maternal obesity, maternal diabetes during pregnancy can affect the child's weight and metabolism later in life. We also know that certain medications or substances during pregnancy can impact weight and metabolism down the road as well. And then there is data about newborn and infant feeding and how certain feeding methods might be preferable in terms of preventing obesity. And so educating mothers, early in life, or even before the birth of their child so they're prepared to make choices that can help down the road.
Shireen: Are you, as you're sort of seeing this and you know, we're with COVID and where things are. So, where do you see things headed for childhood obesity? The fact of the matter is that we know there are certain foods that we shouldn't eat. There's a lot of lifestyle modification to be made around it. Why do you think there isn't like this incredible sense of urgency? I mean, pandemic aside, certainly, but why isn't there this, this sense of urgency around it? What, what is really missing?
Dr.Shah: To be honest, this, to me, seems baffling, but there is not a sense of urgency around it. And I think that it goes to show how, in some ways, we don't prioritize the health of our children. You know, pediatricians get paid less, There's less research funding. There's just less invested. We talk about our children being our future and our most important asset, but as a society, we don't always put our money where our mouth is or our legislation, or, you know, our news coverage. I think we are ignoring very large side effects of the pandemic when we don't talk about how this has impacted children's weights and associated conditions.
Shireen: You know, the interesting thing I find is that every parent wants to do what's right for their child, right? And in the, you know, the reason why I mentioned a minute ago is when you look at diabetes, how far type twos in particular, when we look at obesity, How much it is spreading at an earlier and earlier age. Right? And we're seeing all of this creep more and more into childhood obesity when you were talking about the various ethnic groups, and you talked about sort of the socioeconomic barriers.I mean, there's the genetic side, which is like, you know, can't do much there, but when you're talking about everything else, how would you see in an ideal world, if your doctors had to create that ideal scenario? What would that look like? How could we potentially prevent this from creeping more and more into our, into our youth in adolescents?
Dr.Shah: And if every parent had access to healthy food and I mean, not just grocery stores, but money, to buy those things for their family. You know, we talk a lot about food deserts and that's definitely part of it. But food insecurity is huge. And contrary to what you might think. Children who are food insecure are much more likely to be obese because their families do rely more on the cheaper processed food options.
Not to mention when we have food insecurity we’re also looking at a family that is also undergoing all the other stressors associated with poverty. So, you know, in an ideal world, every family would have access to healthy food. Every family would have someone who had a work schedule that allowed them to prepare healthy meals and eat together as a family.
Everyone would be every caregiver would be healthy enough to engage in physical activity for their children. Every child would have access to sports or a clean and safe outdoor space to run around and play and be active instead of sitting at home on a screen because that's where it's safe. So in an ideal world, all children would have access to what only certain children have access to right now. And I think that can go a whole, long way in smoothing out some of these disparities.
Shireen: I want to now talk about what else you're seeing in this space, in terms of research. Can you shed some light on where things are headed?
Dr.Shah: So we're actually really optimistic about having more treatment options in pediatrics, both in terms of obesity and in type two diabetes. Until very recently, the only treatments for diabetes in children were insulin and one mild affective, but, kind of old school, oral medication, Other options for diabetes that are more likely to result in weight loss or protection from heart disease have been widely available in adults and are now starting to become available for teenagers and younger kids.
We're also starting to think about treating obesity in kids similar to what we do in adults. More studies on in kind of aggressive dietary changes, weight loss, medications, and bariatric surgeries. So we're hopeful that these treatments that adults have been using for obesity and has led to some improvement in rates over time will start to be available for our younger children. So again, they don't have to wait until they're 18-23 to get the treatment that they need just because of their age.
Shireen: Interesting. You mentioned medications. Can you speak to some of that or what's being looked at there for children?
Dr.Shah: Yeah. Currently there aren't many medications that are FDA approved for obesity in children, just over the past year, a GLP one agonist called substantive, which is a daily injection, became FDA approved for children with obesity, teenagers. Unfortunately, insurance coverage is very narrow and most pediatric endocrinologists who have found that they've tried to prescribe this medication,have just run into barriers in terms of getting coverage and patients being able to actually pay for the medication because it is very expensive. But we are also hoping that there will be wider coverage for that medication, as well as expanding weight loss indications for some of the other oral medications that are sometimes used off label.
Shireen: Dr. Shah we're toward the end of the episode. At this point, I'd love for our listeners to know how they can connect with you and just learn more about you.
Dr.Shah: Yeah, my faculty websites and the website for the healthy weight program at the children's hospital are going to be linked in the show notes. I am not big on social media, but I recently joined Twitter. So you can keep an eye out for anything new at, at M D dash R a C H a N a.
Shireen: Lovely. Thank you so much for your time, Dr.Shah. This was very interesting. I love the discussion that we had today, uh, for our listeners out there. Join us on social media and answer this one question. What is the one thing you wish you knew earlier about childhood obesity and diabetes? Head over to our social media and answer that question again, Dr.Shah, thank you again!
Dr.Shah:Thank you so much. It was a pleasure to talk.
Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn. For tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspectives. You can also visit our website Yumlish.com for more recipes advice and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week's show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we'll see you next time. Remember your health always comes first. Stay well.
This episode is part of our series dedicated to national childhood obesity month for the month of September. With this episode and the rest in the series, we hope to increase awareness around childhood obesity and connect you with experts to help you better prevent childhood obesity and support related initiatives.