"Obesity is dangerous," warns diabetes specialist Dr. Ravi Shankar. "Besides the social issues, obese children are at immediate risk of serious health problems that include high blood pressure, lipid abnormalities, metabolic syndrome, and sleep apnea. It is also important to note that the majority of obese adolescents become obese adults. From all perspectives, we know that obesity is not benign."

The NHW met with pediatric endocrinologist and diabetes specialist Dr. Shankar, director of diabetes programs at Riley Hospital for Children, Indianapolis, to learn what you can do to help children avoid the lifelong consequences of obesity.

NHW: Are you witnessing the trend in your clinic?

RS: In the last 10 years alone, the number of children and adolescents diagnosed with type 2 diabetes has increased several-fold. In my clinic, 68 out of the 70 patients I see with type 2 diabetes fit the definition of obese. The other two patients with the disorder are overweight but incredibly insulin resistant--even being overweight has created problems for these two children.

NHW: How do you measure obesity in children?

RS: Using CDC criteria, if a child's body mass index is between the 85th and 95th percentile, that child is overweight. If it is greater than the 95th percentile, the child is considered obese.

NHW: In addition to obesity, what risk factors for diabetes should parents be aware of?

RS: Acanthosis is also an important risk factor. Acanthosis is a skin condition that signals insulin resistance and appears as dark, velvety patches of skin around the neck and armpits of the patient.

Another factor is a positive family history. If one parent has diabetes, there is a higher risk of their children developing the condition. If both parents have type 2 diabetes, the risk of type 2 diabetes in their obese child is much higher.

Finally, certain ethnic minorities are at high-risk, including African Americans, Hispanics, Asian Indians, and other Asian populations. All are genetically at higher risk for developing type 2 diabetes than Caucasians.

NHW: What symptoms most often present in children?

RS: Children present with the classic symptoms of diabetes--constant thirst, constant urination, and perhaps weight loss. Despite the weight loss, however, these children are still obese. Unlike adults, children with type 2 diabetes can present explosively with severe dehydration, massive abdominal pain, and alterations in consciousness, called diabetic ketoacidosis--the hallmark of type I diabetes. But for the majority of patients with type 2 diabetes, symptoms of diabetes are very subtle, which is why it is important to screen everybody at high risk.

NHW: How often should a child at high risk undergo screening?

RS: It is very important to screen children at high risk at least every two years as recommended by the American Diabetes Association. Fasting plasma glucose (sampled after a 10-12 hour fast) is the recommended screening test. I suggest that children at high risk be screened every year at the minimum.

NHW: Do you urge the youngsters to exercise?

RS: I actually write "exercise" on a prescription pad, telling them that they have to work out for 45-60 minutes every day of the week. Exercise has an excellent effect on insulin sensitivity, blood pressure, cholesterol levels--even without major changes in weight. If a person actually loses weight by exercising, it would amplify the effect of exercise. It doesn't have to be an organized activity or anything fancy. They can simply put on a CD and dance at home for 45-60 minutes every day.

NHW: Would re-instating PE classes help?

RS: If schools mandated PE classes every day from elementary through high school, that would ensure at least five days of physical activity a week. By investing in a PE program with 40-45 minutes every day of physical activity, we can make a serious investment in the health of our nation's youth.