June 29, 2003
Diagnosis and Symptoms, Other
Question from Madison, Wisconsin, USA:
My 12 year old stepson has been overweight since age four. His BMI, using the CDC’s charts for kids, puts him at the 94% percentile where he has been the past few years. Over the years, he has seldom joined his brothers (my son and older stepson, now aged 13 and 14) in outdoor play, preferring sedentary activities such as TV and video games. We are an active family and try to set a good example by eating well and exercising regularly, but my step-son is often too tired to participate fully. He falls asleep any time he is in the car for more than 10 minutes and goes to bed before anyone else in the family because he is tired.
Lately, I’ve been keeping track of his food intake and have noticed his consumption of simple sugars is very high, especially in comparison to the rest of the family. Though we usually keep sugary snacks (cookies, regular soda) out of the house, he still seems to seek out high-sugar foods and averages over 120 grams per day. At the same time, he avoids fruits and veggies, gravitating towards breads and cereals instead. He also drinks much more fluid than anyone in the family and frequently has to urinate urgently. Road trips have us stopping at least once an hour, and he struggles to make it through a one-hour football practice without taking a bathroom break.
Even if he doesn’t show signs that would warrant immediate attention, I still feel as though we should be concerned for his future health and ought to pay closer attention to diet, exercise, and energy level. As far as we know, nobody in the immediate family has had diabetes. Should my stepson be tested in any way? Could you please provide some guidelines that we might use to encourage a more healthy lifestyle?
Answer:
The sedentary lifestyle and his current over-weight status are certainly putting him on the road to diabetes, typically type 2 diabetes. For a 12 year old, that is a sad forecast.
The urinary habits that you describe warrant a check now for diabetes. A screen would be urine test for glucose easily done in the doctor’s office. A better screen would be an actual fasting blood sugar test. Even if he does not have diabetes, he may be glucose intolerant (or what some prefer to describe as “prediabetes”) which may require additional testing such as a comparison of the fasting glucose to another one done about two hours after a carbohydrate-rich breakfast. Rarely is a formal glucose tolerance test required. (If it is done, it should be done correctly. See other related links on this web-site for the nuances of an oral glucose tolerance test.)
Heavy folks tend to be insulin resistant, meaning that their insulin works less efficiently, thus requiring them to make more. This can lead to a variety of metabolic changes and can drive hunger — often with preferences for starchy or sugary foods.
Your step-son deserves a formal visit with a dietitian. Despite his desires, it would be prudent to limit his intake of these complex carbohydrates. Have him evaluated by his doctor and ask for a referral to a dietitian. I will add that families who make lifestyle (diet and activity) changes together, for the sake of the one child, generally have better success than the families that single out that child with a specific diet that no one else need follow. Based on your description of your lifestyles, maybe that won’t be a big hurdle for you.
DS
