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Overweight Teens Develop "Adult" Disease

Why a growing number of teens are developing a form of diabetes usually seen only in adults

This story was originally published in Current Science, a publication of Weekly Reader Corporation.

There was a time when Jonathan Schwartz, a high school student from Virginia Beach, Virginia, would eat an entire cake at one sitting. Not anymore.

During a physical examination before football season when he was 15, Jonathan found out that his urine contained a large amount of sugar. Normally, urine doesn’t contain any sugar.

Doctors told Jonathan that he had diabetes, a condition in which the body lacks the ability to use sugar properly. People with diabetes are more likely to experience heart disease, stroke, kidney failure, and blindness.

Jonathan had a form of diabetes that typically occurs only in adults. The news stunned Jonathan. "It was like my bubble had been burst," he said.

Jonathan’s bubble isn’t the only one bursting. An alarming number of teenagers are developing a form of diabetes that occurs most often in adults. Doctors say this dramatic increase is directly related to the large—and growing—number of severely overweight teens.

A recent study indicates that in the United States, the number of people developing diabetes has increased an astounding 33 percent in just eight years. In diabetes, body cells aren’t able to take in glucose, the body’s primary form of energy.

The body obtains energy from food. It breaks down the food into protein, fat, and other substances. One of those substances is a form of sugar called glucose. Glucose from food enters the bloodstream and travels to cells throughout the body.

To use glucose for energy, cells need the help of a substance called insulin. Insulin acts like a key to unlock cells and allow glucose to enter.

In a person with diabetes, the body doesn’t produce enough insulin or the insulin doesn’t work properly and can’t unlock the cells. As a result, glucose is unable to enter body cells. Cells must then break down fats and proteins to obtain the energy they need.

When glucose can’t get into cells, it builds up in the bloodstream. This buildup causes signs of diabetes, most commonly weight loss for no apparent reason and excessive thirst, hunger, and urination.

Doctors say diabetes can appear in two forms, type 1 diabetes and type 2. Both forms appear in people who inherited from a parent or other close relative the tendency to develop the disorder.

In type 1 diabetes, the pancreas stops producing insulin entirely. The pancreas, a small gland located behind and below the stomach, contains highly specialized cells called islet cells. Normally, islet (pronounced EYE-let) cells produce insulin and release it whenever needed.

In some people, though, the islet cells lose their ability to produce insulin. The person then needs insulin injections to survive. Most children and teens with diabetes have type 1 diabetes and need to inject themselves with insulin for the rest of their lives.

Adults, on the other hand, typically develop type 2 diabetes. In type 2 diabetes, the body may stop making insulin in sufficient amounts to meet the body’s needs. Or, the insulin produced doesn’t quite fit into the "lock" on the body’s cells.

Until the last few years, hardly any teens developed type 2 diabetes. Dr. Robin Goland, co-director of the Naomie Berrie Diabetes Center in New York City, told Current Science that from one-third to one-half of all new cases of diabetes in the U.S. are of the type 2 variety.

Most kids who develop type 2 diabetes are obese and inactive. Obesity has become so common in the U.S. that one in six people are now considered obese. Doctors say a person is obese if his or her weight is greater than 20 percent of the person’s ideal body weight.

Inactivity among teens is also on the rise. More and more kids are spending more time than ever surfing the Internet, watching television, or playing video games. They’re also spending less time playing sports or engaging in other forms of exercise.

Dr. Goland said obesity and inactivity lead to insulin resistance, a condition in which body cells become less responsive to insulin. When that happens, the pancreas works harder to produce more insulin. Cells don’t respond to that insulin either, which in turn, causes the pancreas to work even harder.

Eventually, the pancreas tires out and stops producing insulin entirely. The individual then requires insulin injections to survive.

Insulin resistance and related effects make it much more difficult to control blood glucose levels and avoid complications of the disorder. For instance, a consistently high blood glucose leads to damaged blood vessels throughout the body. This damage in turn can lead to impaired vision and blindness, kidney damage, and an increased risk of heart attack and stroke.

"While all this is happening," explained Dr. Goland, "you might feel absolutely fine."

Complications such as blindness and kidney disease generally develop over 8 to 10 years, said Dr. Goland. So when type 2 diabetes develops during the teen years, complications may start to appear in the 20s and 30s. That’s a time when many people have become parents and are responsible for raising a family.

"The good news," said Dr. Goland, "is that there’s a lot we can do to treat type 2 diabetes and keep it under control."

Treatment for type 2 diabetes involves:

• exercise, to improve fitness, reduce insulin resistance, and help maintain a healthy blood glucose level
• more healthful diet
• new drugs that enhance the body’s response to insulin and may eliminate the need for insulin injections in some people
• counseling, to improve the teen’s self-image and help the teen understand how important it is to keep the blood glucose under control.

Aaron Pryor, a 15-year-old from Newport News, Virginia, understands that need extremely well. Aaron learned last year that he has type 2 diabetes.

"Finding out I had diabetes made me want to lose weight more," said the 126-kilogram (315-pound) teen. "It has made me more conscious about how I feel."