- Prediabetic cases in children, unfortunately, have doubled
in the last 20 years, and that is no matter what the income,
the ethnicity, the race, or the education of these kids.
Unfortunately, we're seeing in the broad spectrum
of ages 12 to 19.
Why is that,
and how can we head that off?
Kind enough to join us this morning on WAKR
is Dr. Naveen Uli here on WAKR.
Dr. Uli is the director over at Akron Children's Hospital
when we talk about diabetes.
And Dr. Uli, thanks for joining us this morning,
and let get into the basic question to start,
and that is, why have we seen the increase,
the double, in these cases?
- I think the primary driver
of that increase is a generalized increase
in the number of kids that are gaining weight
a little too fast, so overweight and obesity
has really gone up significantly in the past two decades.
And that is the primary driver
of this increase in pre-diabetes,
as well as the full-blown diabetes
that we are seeing in youth.
- When we talk about pre-diabetes and diabetes in general,
get into the medical aspect of this,
of the troubles not only for the kids at that age,
but certainly on down the road for the rest of their life.
- Absolutely.
So once these children develop full-blown diabetes,
that then triggers a cascade of other organ involvement
and other medical conditions,
and that includes their risk for heart disease goes up,
risk for high cholesterol,
risk for fatty liver disease, sleep apnea,
and so that's really a cascade
of health problems that are then lifelong.
- Yeah.
With us says the director
of the Center for Diabetes at Akron Children's Hospital,
Dr. Naveen Uli, here on WAKR.
So Dr. Uli, let's go to, you mentioned the diet and such
with the kids, but I imagine inactivity,
which goes hand in hand with screen time
and some of the other things are big contributing
factors here.
Talk to the parents to try to hit this off.
- Yeah, so those are the primary drivers
of this also because along with increase
in the total amount of calories consumed
and the amount of empty calories consumed,
those certainly have gone up over the past two decades.
And along with that, there is also the decrease
in physical activity and increase in sedentary behaviors,
which is increased screen time,
and so they're consuming more calories
than before on a daily basis.
At the same time, their bodies are burning less calories.
And the net effect is that there is increased storage
of calories and fat that gives rise
to the overweight and obesity,
which then puts a lot of stress on their pancreas,
which is the source of insulin,
which is key in maintaining normal blood sugars,
and the final result is that blood sugars
start going up initially as pre-diabetes,
then if the process continues,
that then develops into full-blown diabetes,
so really lots of factors that contribute
to this increase in obesity,
as well as pre-diabetes and diabetes.
- Dr. Uli, if you had to sit down and talk with parents
about taking care of these kids
and keeping them out of that arena of pre-diabetes,
you talked about diet,
you talked about sleep and screen time,
but one area, too, that I think parents
need to pay attention to,
and I'm gonna let you expand,
is the schedules of these teens
and how it's changed so much in the last 20 years,
where they're not only doing school,
but then they're doing practice here,
they're doing this there,
they're so involved in so many different activities,
sometimes we overload their schedule,
so what is the fall out of that is the diet is,
having a lot of food on the run,
you know, the fast food, the diet might not be great,
the sleep might not be great,
and then they're doing the screen time to play catch up.
It all matters.
- It certainly matters.
So when there is breakdown in the schedule
and the food intake doesn't happen on a set schedule,
and as you said, there is eating on the go
and reliance on prepared, highly processed foods on the go,
and as we all know, the highly processed foods
are less in nutrients and just loaded with calories,
and empty calories, and that includes sugars, fat and salt,
and really, they're not getting enough exercise
as they used to many decades ago,
and their schedule is completely fragmented,
and these kids are also putting on a lot
of academic activities on their plate,
and so sleep is getting, going down,
and the net effect is, as we just talked about,
which is increase in the weight gain,
and then that leads to increase
in their risk for prediabetes and diabetes.
- On board with us is Dr. Naveen Uli,
again director of Center for Diabetes
at Akron Children's Hospital.
And Dr. Uli, a lot of parents might not understand
screen time and the amount of hours
that our children are spending on that,
I know you probably have statistics,
but you're talking about school time, screen time,
and then inactivity, relaxing screen time, that all add up.
- Absolutely, yeah.
I think, there's more and more reliance
on even academics through screens
and less through the printed books,
and so even the school,
education happens on the screen these days,
and the past couple of years,
what you're seeing is with the COVID-19 pandemic,
and there's breakdown in education,
so a lot of it was virtual, remote.
The screen time has really gone through the roof
as a result, and this was happening
even before the pandemic,
but the pandemic just made it worse,
and I think we have yet to see the effect of the pandemic
in terms of their, the increase in obesity in children
and what effect that has on their risk for diabetes,
heart disease, high cholesterol,
and all those health consequences of increased weight gain.
- Ages eight to 12, the average screen time
is five hours a day.
Ages 13 to 18, now in the United States,
they're hitting seven hours a day.
When you talk about phones, pads,
televisions, computers, all that stuff adding up,
that's a lot of time being inactive.
Dr. Uli, if you had to leave all of us today,
parents and all of us in general,
with some final thoughts on how to do a better job
with the kids to avoid this pre-diabetic arena,
what would be some of the thoughts from you?
- Well, I think starting very early is really important,
and the lessons we've learned in identifying
and managing overweight and obesity in children
really shows us that if you are late in the game,
it is very difficult to reverse those changes,
so starting with early childhood,
look at the trends of the weight gain.
So whenever a parent takes a child
for a well visit to the pediatrician,
pay some time, attention on the trends
in the weight of the child
and also have the pediatrician plot the body-mass index,
which is a calculation of how the weight
compares to the height,
and if that shows a rising trend very early on,
that's a clue that one has to really pay attention there
and nipping in the bud very early
because once the pounds are on the child,
it is difficult to reverse that,
and so start early, pay attention to the weight gain,
pay attention to the body-mass index,
and, of course, pay attention to the schedule of the child,
the eating habits, and also try to cook from scratch,
fresh vegetables, fruits, less processed foods,
cut down on sugar-added drinks,
the juices and the regular sodas,
and kids need physical activity.
The recommendation is at least 60 minutes
of physical activity per day.
And then as you said earlier, the screen time,
really the recommendation is to keep the screen time
under two hours, so really, it's an effort
at all of those levels, starting early
and being consistent in all of those areas
is the key to preventing excess weight gain in children
and preventing their health risks from the weight gain,
which includes prediabetes, diabetes, high cholesterol,
heart disease, liver disease, and sleep apnea.
- Dr. Uli, thank you for the education,
joining us this morning.
We all, believe me,
we all appreciate the time with us today.
Thank you so much.
- My pleasure.
- Dr. Naveen Uli, again, director of the Center for Diabetes
at Akron Children's Hospital.