| Abstract: |
A variety of environmental factors, including poor dietary quality, inadequate physical activity, and sedentary lifestyles, have converged in the past two decades to produce an unprecedented epidemic of childhood obesity and its most serious complication, type 2 diabetes mellitus. This article considers the implications of this epidemic, examines the pathophysiology of type 2 diabetes mellitus in children, and reviews prevention and treatment strategies. All types of diabetes increase the risk for microvascular and macrovascular disease, including myocardial infarction (heart attack), stroke, renal (kidney) failure, blindness, and neuropathy; evidence is accumulating to show that risks for developing these complications may be greater in type 2 diabetes. The authors note that, as a result of this epidemic, the prospect of coronary heart disease becoming a disease of young adulthood must be faced. Treatment focuses on weight loss, dietary composition, physical activity, and drug therapy. This impending crisis demands a concerted public health campaign, calling on biomedical researchers to identify novel treatments for obesity and insulin resistance, public health agencies to device community based prevention strategies, public schools to promote physical activity and fitness, the commercial food industry to market healthful foods to children, and parents to model and support healthful lifestyle choices. The primary care clinician must also play an active role in both the primary prevention of obesity and the timely diagnosis and treatment of type 2 diabetes mellitus in children. A patient education handout on this topic is available in the same issue. 37 references. |