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Caitlin Whyte: Childhood obesity is an unfortunately serious and growing problem in the United States. Today we are discussing this rising trend. It's linked to diabetes and what we can do to curb the problem with Prisma, nurse practitioner and diabetes educator, Laura Szadek. This is Flourish, A podcast brought, brought to you by Prisma Health. I'm Caitlin Whyte. So Laura, to start us off today, how do we know if our child is overweight?

Laura Szadek, NP: Well, that is a great question. It's not really a straightforward answer because in childhood, children's body composition and the amount of body fat, they have changes over time. And there's also a difference between males and females. But the real definition of obesity is when we have excess body fat. And there's different organizations that have different definitions, but here we generally use the Center of Disease Control and their body mass index. So we usually use the term BMI for short.

We can also use waist circumference and skin fold thickness. But generally when you take your child to a pediatrician's office, they will measure their height and weight, and then the BMI is calculated. And what's nice about the BMI, it is age and gender specific. So being overweight, Is considered when the BMI is greater than 95% for your age and gender.

Caitlin Whyte: So if that is what is considered overweight, when is then a child considered obese?

Laura Szadek, NP: Well I would say the cutoff it, is that would be considered obese as well. If you're just concerned about like high risk overweight, I would say between when the BMI is between 85 percentile and 95 percentile.

Caitlin Whyte: So, at what age can a child be considered overweight or obese? I mean, can toddlers and babies be considered obese?

Laura Szadek, NP: Yeah, so with toddlers it's kind of difficult to tell because we love that little fat belly and those rolls on the thighs and we think that baby is healthy because our baby is eating. But the best thing is to talk with your pediatrician or your primary care provider. Look at growth charts, so it's not always just one point in time, but it's kind of the trend over time. In toddlerhood, so under age two, we look at the weight for length percentile. So if that's greater than 98 percentile, then we know that infant's weight is too high for their length, and that's a perfect time for us to start talking with families about nutrition and what they're feeding, the type of milk they're using, and the food that they're, and how they're preparing it.

Caitlin Whyte: So why would it be a problem for kids to be overweight or obese besides the common, you know, just health concerns. Can they develop diabetes?

Laura Szadek, NP: Yeah. So once we've identified that a child is obese or on the path to obesity, it kind of puts 'em on a path to some health challenges. And these challenges were more seen in adults in the past, but now, more recently, we're seeing these in children. So, as you mentioned, Type two diabetes, high blood pressure. In our country, one in five children struggle with excess weight. Usually if you struggle in childhood and adolescence, you're more likely to continue this into adulthood. And there can be a significant impact, not only on their physical health as well as their emotional wellbeing, physically disease such as hypertension, as I mentioned, diabetes issues with cholesterol, even sleep apnea at night, and orthopedic issues.

You can have issues with your lower extremities having to carry that amount of weight on the growing bones. And lastly, it can put down the road you at greater risk for certain cancers such as breasts, colon, esophageal, kidney, and pancreatic. Emotionally, this can affect kids self-esteem, create anxiety, depression, and even kind of set them up for bullying in the social settings.

Caitlin Whyte: So let's focus on diabetes here. I know there are two different types. Can you explain each one of those to us?

Laura Szadek, NP: Yes. So the most common type of diabetes mellitus in children is still type one diabetes, which is an autoimmune process where the body makes antibodies that attack the beta cells that live in the pancreas. And it's those beta cells that make insulin. Once you have type one diabetes, eventually your Pan Andres will not make any insulin at all, and these children will need insulin for the rest of their life. Type two diabetes has actually two components, the body cannot make enough insulin to keep up. But also the body doesn't use the child's own insulin effectively. This is something called insulin resistance.

Now, the exact cause isn't kind of unknown because some kids are obese and have family history and don't go on to develop diabetes. But then we know family history of type two diabetes, family history of obesity, the child being obese themselves, being inactive, and then different ethnic groups actually, Are at greater risk such as our African-American population, our Hispanic-American, and our American Indian. Actually being female puts you at higher risk for developing diabetes. Symptoms of type two diabetes. You may or may not have any symptoms at all.

You could have frequent urination. You can have increased thirst, you might have frequent bladder infections or yeast infections, and females, you might notice that you have skin infections that don't heal well. You might have some blurry vision, headaches, some moodiness, irritability, and if your diabetes has progressed, you can have some nausea, vomiting, and maybe some unexplained weight loss, which does some make sense, but then tingling in the hands and feet as well. The best is if your child is at risk for type two diabetes because of their weight.

Regular checkups, so you can have nutrition guidance, activity guidance, and just checking sugar in the urine is a very simple, easy test that would lead the physician or provider to do some maybe additional tests. Like a blood sugar level in the blood, something called hemoglobin A1C or an oral glucose tolerance test. These tests further confirm diabetes as the diagnosis.

Caitlin Whyte: Well then what can parents do to help their children in this situation? Are any of these reversible in children?

Laura Szadek, NP: Diabetes is not really considered reversible. When you use that word, it sounds like there can be a cure or it's a permanent situation. However, things can go into remission, meaning that their lab work no longer qualifies them for the diagnosis of diabetes, but they are still at risk for things changing over time if they're not consistent with the lifestyle changes that help to maintain their blood sugars. They might not need medication, but they still have to focus on those lifestyle changes. So things that you can do maybe to prevent diabetes in your child is to be open to conversations about your child's weight.

I can say healthy diet, but I also think of it as more like meal planning. The word diet has some connotations, but simple things like avoiding sugary containing beverages, drinking more water, eating fruits and vegetables. The more colors the better. I frequently tell my families to eat all colors of the rainbow. Eating slower at meals so that you get that sense of satiety or feeling full so you don't overeat. Avoid eating in front of the television or computer. I frequently say eat real food, less processed food, and less fast food.

In real food, I tell my families, grows in the ground on a tree or on a bush. It walks on a farm with two or four legs. It swims in the ocean, river or lake. Real food does not live in a package on a shelf. I like to get, I have grandchildren now, but I like to get them involved in meal planning, picking out the food, looking at all the colors, helping with chopping and preparation. Teaching children as they get a little bit older and can read, to look at labels to decide is this a better choice versus a different choice.

Participating in regular physical activity. I will say this is a hard one. If you're coming in and your child is significantly over obese, they don't necessarily feel great exercising because of the weight carried on their skeleton or their frame. So starting small and building from there so they can feel successful. Sometimes I put a walking program in place just for 15 minutes a day. I also try to encourage the family to help the child with this or go along, be their partner, be their coach. You don't have to be on a varsity sport. To participate in regular physical activity, and it doesn't all have to be at once. It can be in 10, 15 minute increments working up to an hour a day of physical activity.

And of course, limiting time spent on electronics, which is hard now because most education involves some sort of electronic use. So just limiting kind of electronics that are done for pleasure or enjoyment. And lastly, there's a lot of research going into sleep and its relationship to weight concerns in obesity, in childhood and in adulthood. So our children need adequate sleep, and this is where electronics, television, computers, cell phones, might be interfering with the child being able to fall asleep at night. So our recommendation is no electronics an hour before bedtime so that the body can enter a normal sleep cycle.

Caitlin Whyte: Well, that leads me to my next question. Can you talk about the connection between childhood obesity and mental health?

Laura Szadek, NP: There is a lot going into this as well as far as research. The question is, does some of the mental health issues cause obesity or does obesity cause mental health issues and some issues? It is a bidirectional relationship. Some, it's just a unilateral relationship, but depression can definitely be a cause that leads to overeating and it also can be a consequence of obesity. These kids tend to have low self-esteem. They're a target for bullying and being teased. We kind of put a prejudice and stigmatism towards these children.

And the other concern is as you address this educating families, being cautious of not to shame the families because I also worry about eating disorders as we talk about restrictive eating, binge eating, emotional eating, and these kids can also have body dissatisfaction, which tends to be higher in males, interesting enough than females. So stress eating, we talk a lot about in my clinic because you can eat, stress can be good stress, it could be negative stress. You can eat when you're happy, mad glad and sad, and kind of recognizing, am I stressed at this moment or am I just truly hungry?

And we try to teach the families how to recognize the difference between both. So I usually say, if you're truly hungry, You'll eat anything like carrots and apple. If it's stress eating, you're usually grabbing something that's salty, crunchy, or sweet.

Caitlin Whyte: Well as we wrap up here is it's safe for kids to go on fed diets like keto or anything else we hear about in the news?

Laura Szadek, NP: Well, keto diet is getting a lot of press and it is actually, believe it or not, a treatment for children with epilepsy who aren't treated successfully with medication. And this diet is very high in fat and contains a very small amount of carbohydrates. Children that go on the keto diet that have epilepsy are under very close monitoring, working with neurologists and dieticians, have that have been trained to help these families, and their diet is very controlled. Just everyday children need carbohydrates for growth and development. They need it mentally and physically so they can remain active. So a ketogenic diet that we hear in the news or read about on the internet is not necessarily a healthy choice.

If I was going to recommend anything to families that ask these questions, we talk about maybe the Mediterranean diet, which the carbohydrates in that diet tend to be much healthier versus a carbohydrate. That's a, I call it the seed. The cake, the cookies, the candy, the chips, the cereal. The carbohydrates that come from the Mediterranean diet tend to be from beans and fruits and vegetables. So more, again, going back to that eating real, but fad diets and children would not be a healthy option.

Caitlin Whyte: Well, thank you so much for your work and your time, Laura. We so appreciate it. For more information and other podcasts just like this one, head on over to prismahealth.org/flourish. This has been Flourish. A podcast brought to you by Prisma Health. I'm Caitlin Whyte. Stay well.