It seems obvious to me that early-onset obesity should have a statistical association with coronary heart disease in adults. Obese kids, many but not all of whom are insulin-resistant, have the vascular disease whose end-stage is Type 2 diabetes. What, you may be saying, is she talking about?
We know that individuals who are pre-diabetic and/or have metabolic syndrome have an increased risk of heart disease and stroke. It suggests that diabetes per se doesn’t cause the heart disease, rather an earlier pathology causes vascular disease and, after a period of time, results in Type 2 diabetes. We also know that abdominal obesity, particularly visceral fat, is linked to the onset or worsening of insulin resistance. Insulin resistance, in turn, is linked to a number of abnormalities including fatty liver, high blood pressure, atherosclerotic vascular disease, and eventually coronary heart disease, stroke, and diabetes.
Global epidemic of childhood obesity
What is alarming is that we used to see Type 2 diabetes primarily in adults. With the global epidemic of childhood obesity, we are now seeing this type of diabetes in children, some as young as pre-school. In fact, in some at-risk populations, such as black and Hispanic adolescents, Type 2 diabetes is now more prevalent than Type 1 diabetes—a disease that used to be called juvenile onset diabetes to differentiate it from adult onset (now called Type 2).
An article in the December 6, 2007 New England Journal of Medicine recently documented that higher childhood BMIs are associated with an increased risk of coronary heart disease in adulthood. Although the association was stronger in boys than in girls, in both, it increased with the age of the child. The authors conclude, “Our findings suggest that as children are becoming heavier worldwide, greater numbers of them are at risk of having CHD in adulthood.”
A second article in the same journal examined the relationship between adolescent overweight and future coronary artery disease. Using the CHD Policy Model, a computer simulation of U.S. residents 35 years of age or older, the researchers projected the annual incidence and prevalence of CHD based on historical trends of overweight adolescents who became obese adults. They concluded that, by the year 2035, the prevalence of CHD will increase by a range of 5 to 16% with more than 100,000 excess cases of CHD attributable to obesity.
In an editorial accompanying these two articles, David Ludwig, MD, an expert in childhood obesity likens the obesity epidemic to global warming. Like global warming, we have had warning signs about the childhood obesity/diabetes problem for decades, but we couldn’t seem to focus on it.
A looming crisis
Dr. Ludwig rightfully points out, we are facing a “looming crisis that requires action before all scientific evidence is in.” I agree.
We have been watching our kids get fatter and fatter. We have been talking amongst ourselves about how pediatricians have had to learn how to care for Type 2 diabetics. But, we haven’t really applied a concerted country-wide, multi-stakeholder effort to do anything to stem the tide. Sure, individual families will have to do their part. But the root causes of this epidemic are way beyond just “personal responsibility”. With billions of dollars spent to advertise junk food to us and our kids, with a decline in time to exercise in schools and in the workplace, and with stress on the rise, we have set up the perfect storm of healthcare…and, no question, the results are going to be deadly.