The increasing incidence of type 2 diabetes and cardiovascular disease can be attributed to a large extent to the rising obesity in children and adults all over the world. Type 2 diabetes is increasingly being diagnosed at an early age. The rising prevalence of childhood obesity has become a major concern. Several observational studies have shown that obese children and adolescents acquire markers of increased cardio metabolic risk such as insulin resistance, dyslipidemia and subclinical inflammation at an early age and these may persist into adulthood. Longitudinal studies on other ethnic populations have demonstrated that in children change in body mass index (BMI) percentile, presence of metabolic syndrome and family history of diabetes predicts increased risk of development of type 2 diabetes in adulthood. Studies on Indian population have also shown that one standard deviation (SD) increase in BMI in childhood increases the risk of development of dysglycemia by about 1.4 times. Childhood obesity not only predicts development of type 2 diabetes, but it may also predict diabetes-related mortality. Overweight and obesity in adolescence have been shown to have hazard ratios of 8.0 and 17.2 for diabetes-related mortality, respectively. Even BMI in normal range was observed to predict diabetes-related mortality in this cohort. This may be particularly true in children and adolescents of Asian Indian ethnicity as they have been shown to develop insulin resistance, subclinical inflammation and metabolic syndrome at a relatively lower BMI than their western counterparts.
Early interventions in preventing and treating childhood obesity can be beneficial in prevention of type 2 diabetes in adulthood. Data from longitudinal studies has shown that obese children who continued to be obese as adults had increased risk of development of type 2 diabetes and other cardio metabolic abnormalities. In contrast, the risk of these outcomes in obese children who became non obese by adulthood was similar to those who were never obese. Therefore, it is important to intervene in childhood to prevent obesity and other complications. Lifestyle interventions in the form of diet and physical activity changes form the cornerstone of the management strategy. A multi-component intervention, which is school, family and community based, may be necessary for effective management of childhood obesity. Existing evidence indicates that such an approach may be moderately effective.