By Maria Arana, LWDI Intern
Adolescence is one of life’s most challenging transitions. This stage of life is filled with new emotions, changes, relationships, and unforgettable lessons. As if these struggles were not challenging enough, dealing with obesity and type 2 diabetes can add to the stress. A diagnosis of this magnitude can be overwhelming and scary all at once. Despite this rollercoaster ride of emotions, the most important thing to keep in mind is that individuals still have some control over their health. Understanding obesity and type 2 diabetes is a step in the right direction.
The Link Between Obesity and Type 2 Diabetes
Numerous journals, such as the Diabetes Care journal, demonstrate that obesity and excess weight are significant contributors to developing insulin resistance.  Obesity also plays a role in cognitive and social problems in adolescents. These problems can often lead to discrimination, low self-esteem, depression, dissatisfaction with body image, and many other psychosocial issues.  Despite these consequences, obesity statistics continue to rise in this age group. Data shows that 5% of US adolescents were obese in the year 1980.  By the year 2012, 21% of US adolescents were obese.  These numbers have more than tripled in the past three decades!
Genetics, race, and family history play a significant role in developing type 2 diabetes. However, environmental factors such as obesity most often trigger the onset of this preventable disease.  The American Diabetes Association states that “the earlier an individual develops type 2 diabetes, the higher their lifetime risk of diabetes complications such as heart disease, vascular disease, vision loss, and amputation will be.” 
What Goes on Inside the Body with Type 2 Diabetes?
Type 2 diabetes is a chronic condition that affects how the body regulates blood glucose (sugar).  After eating a meal, the body turns the food into glucose, which travels in the blood system until insulin is released. Insulin, a hormone made by the pancreas, works like a key and allows glucose to enter the cells to be used as energy.  However, with type 2 diabetes, the body either does not produce enough insulin or becomes resistant.  When this happens, blood glucose can become too high.
Making lifestyle modifications is a very personal decision, and it may not be the easiest thing to do. It is recommended that adolescents with obesity and type 2 diabetes aim to achieve a 7-10% decrease in excess weight.  However, family members must help with this process by engaging all members in making new lifestyle changes.  It can also be helpful to speak to a physician before making these changes. Working with a registered dietitian can help clear up any misconceptions about nutrition and help make individualized meal plans that will properly nourish the body.
Get Daily Exercise
A sedentary lifestyle can lead to weight gain. Therefore, the 2015-2020 Dietary Guidelines for Americans recommend that youth ages 6-17 get at least 60 minutes of physical activity daily.  Incorporating a mixture of aerobics, muscle-strengthening, and bone-strengthening exercises are recommended.  In addition to weight improvements, regular physical activity decreases the risk of coronary heart disease, stroke, high blood pressure, depression, type 2 diabetes, and much more. 
Community centers often offer exciting and inexpensive exercise classes, such as dance and yoga, to the community. These classes can be a great way to get involved, meet new people, and a creative way to get moving!
Use the Diabetes Plate Method
Large food portions often lead to excessive consumption of calories. With time this may lead to a significant increase in weight. The Diabetes Plate Method is a great guide to help individuals choose healthy foods and be mindful about portion sizes.  This guide works well for many because it eliminates the need to count, calculate, or measure food.  According to the American Diabetes Association, this method starts with using a reasonably sized plate—a plate that is 9 inches across works perfectly. 
First, fill half the plate with nonstarchy vegetables such as:
- Leafy greens
Second, fill one-quarter of the plate with lean protein foods such as:
- Lean pork
- Lean beef
- Any plant-based meat substitutes
Finally, fill one-quarter of the plate with a carbohydrate food choice such as:
- Grains (brown rice, quinoa)
- Starchy vegetables (potatoes, peas, corn)
Carbohydrate food choices are limited to one-quarter because they have the most significant impact on blood glucose levels.  For beverages, choose those that do not contain calories or added sugars, such as water, unsweetened tea, or any other calorie-free beverage.
The Importance of Diabetes Self-Management Education
Youth diagnosed with type 2 diabetes have a greater risk of accelerated diabetes-related complications. Type 2 diabetes diagnosed at a younger age is also associated with a greater risk of cardiovascular morbidity and mortality.  Therefore, diabetes self-management education is vital to successfully teach adolescents how to control and measure blood sugar levels, reduce mortality risks, and learn more about lifestyle modifications.  It is important to understand that diabetes self-management education will require periodic reassessment, especially as an adolescent grows, develops, and has a greater need for independent self-care skills. 
The Positive Effects of Weight Loss in Adolescents
Studies show that lifestyle interventions, such as physical activity, improves insulin sensitivity independently from weight loss. [8, 9] Dietary patterns also contribute to overall health. For example, it is known that weight loss is promoted when dietary patterns are rich in whole grains and fiber.  Many of these high fiber foods come from fruits and vegetables. In some instances, pharmacologic interventions may be necessary for some individuals. Therefore, it is crucial to speak with a physician and a registered dietitian about these options. In essence, whether adolescents are newly diagnosed or have been living with type 2 diabetes for a while, they have control to redirect their lives and make the most out of those years of youth!
1. Arslanian S, Bacha F, Grey M, Marcus M, White N, Zeitler P. Evaluation and Management of Youth-Onset Type 2 Diabetes: A Position Statement by the American Diabetes Association. Diabetes Care. 2018;41(12):2648-2668. doi:10.2337/dci18-0052
2. Mazloomy-Mahmoodabad SS, Navabi ZS, Ahmadi A, Askarishahi M. The effect of educational intervention on weight loss in adolescents with overweight and obesity: Application of the theory of planned behavior. ARYA Atheroscler. 2017;13(4):176-183.
3. Rao PV. Type 2 diabetes in children: Clinical aspects and risk factors. Indian J Endocrinol Metab. 2015;19(Suppl 1):S47-S50. doi:10.4103/2230-8210.155401
4. Galuska D, Gunn J, O’Connor A, Petersen R. Addressing Childhood Obesity for Type 2 Diabetes Prevention: Challenges and Opportunities. 2018;31(4):330-334. doi: https://doi.org/10.2337/ds18-0017
5. Healthy Eating Patterns: Dietary Principles – 2015-2020 Dietary Guidelines | health.gov. Health.gov. https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/chapter-1/healthy-eating-patterns/#callout-physicalactivity. Published 2020. Accessed December 7, 2020.
6. Intechnic h. What is the Diabetes Plate Method?. Diabetes Food Hub. https://www.diabetesfoodhub.org/articles/what-is-the-diabetes-plate-method.html#:~:text=The%20Diabetes%20Plate%20Method%20is,you%20need%20is%20a%20plate!. Published 2020. Accessed December 7, 2020.
7. Care.diabetesjournals.org. https://care.diabetesjournals.org/content/43/Supplement_1/S163.full-text.pdf. Published 2020. Accessed December 15, 2020.
8. Tagi V, Giannini C, Chiarelli F. Insulin Resistance in Children. Pediatric Endocrinology. 2019. doi:https://doi.org/10.3389/fendo.2019.00342
9. Mahan L, Raymond J. Krause’s Food & The Nutrition Care Process. Pages 586-617