Metabolic Syndrome of Obesity in Teens Predicts Risk as an Adult
by Connie Guttersen, RD PhD,
author of the Sonoma Diet
The super sizing of our American teens is of greater concern than ever before. This news comes to us from information presented at the American Heart Association 44th Annual Conference on Cardiovascular Disease, Epidemiology and Prevention in March 2004. The information concludes that American physicians may be underestimating the incidence and complications related to teenage obesity. As many as 2.1 million teens who have metabolic complications of obesity are slipping through the cracks when it comes to clinical diagnostic measures. Researcher, Carolyn Tabak, MD, from the Strong Children's Research Center of the University of Rochester in New York concludes in this study that pediatricians and other physicians often measure obesity in teens with the same percentile formula used for toddlers and elementary school aged children.  The study included an analysis of data collected in a National Health and Nutrition Examination Survey or NHANES III, which collected data from 2392 teens aged 12 to 19. The survey included BMI and measurements of waist to hip ratio, blood sugar levels, high density lipoproteins, triglycerides, and blood pressure. Approximately 11% of the teens had BMIs of 25 or greater but did not meet the pediatric standard for overweight because their BMI did not place them in the 95th percentile or higher. These same teens also displayed evidence of clinical risks which are part of the diagnosis of metabolic syndrome. Twenty-eight percent had low levels of high density lipoproteins, more than 8% had high blood pressure and about one-third had elevated blood triglycerides. This study highlights the importance and difficulty of accurately diagnosing weight problems in teens before the health risks of obesity flourish into a more pronounced metabolic syndrome.
Just ten years ago type 2 diabetes in teens was rare, by 1999 the rise in childhood type 2 diabetes was ten fold. Virtually all children and teens with type 2 diabetes are overweight. The other point which impacts the health of our teens is that teens today are gaining weight twice as fast as their parents. University of Iowa researcher, Patricia Davis, MD concludes that with this increased risk for greater BMIs comes an increased risk for heart disease at an earlier age. So what has changed between the 1970's and today? Several factors, most notably poor diets, especially an increased reliance on fast foods and a more sedentary lifestyle.
Longitudinal data from the Bogalusa Heart Study, a long term community based study of cardiovascular risk variables from childhood to young adulthood, examine predictors of metabolic syndrome (syndrome X) in adulthood. The study reflects that childhood and adolescent obesity is the strongest predictor of metabolic syndrome (syndrome X ). TOP
| Risk Factors for Metabolic Syndrome |
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| Insulin Resistance |
Abdominal Obesity |
| Decreased High Density Lipoprotein |
Increased Blood Triglycerides |
| Smaller, Denser Low Density Lipoproteins |
Increased Apo B proteins |
| Hypertension |
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Metabolic syndrome (also known as syndrome X) has become the major health problem of our times. We never would have imagined that health professionals would be addressing this concern for our American children and teens. However, with unprecedented levels of overweight and obesity in conjunction with poor diets (excessive calories, processed and refined carbohydrates, saturated and hydrogenated fat consumption) and a lack of exercise, the expression of this syndrome has made it a modern day reality. Being overweight during childhood and adolescence is associated with high levels of fasting insulin, blood lipids, blood sugar levels and blood pressure in young adulthood.
 The bright side of this is that with teens the negative effects of a bad diet and too little exercise can be reversed very quickly with the proper regimen. James Barnard, PhD, professor at University of California, who also presented at the American Heart Association meeting, found that after two weeks of a diet and lifestyle program aimed for teen and parent participation, teens experienced a 26% drop in total cholesterol, a 36% drop in low density lipoproteins, and no decrease in the high density lipoproteins. TOP
 Teen Treatment Challenges
Perhaps one of the most challenging aspects of developing a treatment plan for teens is addressing dietary issues and eating habits. It is quite different than feeding a small child. Many teens have established eating habits and styles which dictate food choices, more than often, not healthy ones. Marketing of fast foods, snack foods, and peer pressure can directly influence food choices. For many teens self esteem is directly tied into being "thin" and unfortunately, unhealthy eating habits may arise from this. Data from numerous studies have demonstrated a high prevalence of weight control behaviors among adolescents, primarily girls. In previously reported findings from the Project EAT (Eating Among Teens) study, 45% of adolescent girls and 21% of adolescent boys reported that they were currently trying to lose weight, and an additional 25% of girls and 23% of boys were trying to maintain their weight. What was also reported in this study was that 57% of the girls and 33% of the boys were using unhealthy behaviors to control weight. These unhealthy behaviors included skipping meals, fasting, using food substitutes, or smoking. An additional 12% of the girls and 5% of the boys reported extremely unhealthy behaviors which included the use of laxatives, diet pills, diuretics, and vomiting. Analyzed data further concluded that of those girls engaging in unhealthy weight control behaviors there was a lower intake of fruits, vegetables, and grains as compared to girls not reporting any weight control behaviors. The specific nutrients which were consumed in lower amounts included calcium, iron, vitamins C, A, B-6, folate, and zinc. Many of these nutrient deficiencies, such as folate, vitamin b6, antioxidants C and beta carotene are associated with risk for developing insulin resistance and syndrome X. "Dieting" among teens tends to be associated with a poorer dietary intake. It is important to teach adolescents how to "watch" or "diet" so that if energy intake is reduced, the nutrient density of the diet remains stable and adequate. Eating behaviors must also be recognized since unhealthy behaviors often impact on food choices. TOP
| Unhealthy Weight Control Behaviors in Teenage Girls: Increased Risk of Deficiency For Nutrients |
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| Vitamin A |
Zinc |
| Folate |
Iron |
| Vitamin C |
Calcium |
| Vitamin B6 |
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Dietary Fats & Teens.
Due to the widespread popularity of fast food and processed snacks, the intake of saturated and hydrogenated fat becomes a concern for diet quality. The type of dietary fat consumed by teens is important. Scientific evidence indicates that specific types of dietary fat play a protective role against type 2 diabetes and metabolic syndrome. Monounsaturated fats, such as those found in olives and nuts, may be beneficial for glucose and insulin homeostatis as well as improving insulin sensitivity. While other studies have concluded that a high intake of saturated fat and trans fat adversely affects glucose metabolism and insulin resistance. The mechanisms by which specific types of dietary fat affect insulin sensitivity are not fully understood. One explanation may be that the fatty acid composition of the phospholipids in the muscle cell membranes is directly related to insulin sensitivity. In addition, specific types of fatty acids in the cell membrane could influence insulin action via altering the insulin receptor binding or influencing the ion permeability and cell signaling.
Improving the Diet Quality of Teens via Nutrient Selection
- Choose healthy fats such as monounsaturated, omega 3 and polyunsaturated sources.
- Choose more whole grains breads over refined.
- Choose low glycemic foods.
- Eat a wide variety of fruits and vegetables.
- Choose more plant proteins such as beans, legumes, and nuts over animal protein.
- Limit carbonated sweet beverages and soft drinks.
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The types and amounts of food consumed by children and adolescents have contributed to the obesity problem. Large population studies such as the National Health and Nutrition Examination Study ( NHANES III), the Continuing Survey of Food Intakes by Individuals (CSFII), and the US Food Supply Series provide valuable information regarding what Americans are eating. In general, these studies tell us that the amount of calories we eat each day has increased over the last twenty years by 15%. This accounts for an additional 150 - 200 calories per day. Ninety percent of this increase comes from a higher consumption of refined grains, sugars, and fats. The results of these studies are often based on a 2200 calorie per day intake. However, the results of these studies signify trends of the types of foods which are consumed by all ages. Some of the highlights of these studies are listed below.
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Highlights: What Americans
are eating today.
(NHANES III, CSFII,
USDA ERS 1999)
- Less than 1/2 of the recommended amount of fruit is eaten. The amounts eaten reflect a limited selection. Out of the 60 or more types of fruits available to us, Americans primarily ate only 6 types. Orange juice and bananas being the most popular.
- Americans ate the recommended amount of 4 vegetable servings per day. However, the selection was limited in terms of variety and nutrient dense choices. Five foods: iceberg lettuce, French fries, potatoes prepared in other ways, and canned tomatoes accounted for 53% of the total amount of vegetable servings.
- The combined consumption of dark green leafy vegetables and deep yellow vegetables accounted for less than half of one serving per day. Similar figures were also seen for the intake of legumes and beans.
- Americans fulfilled their grains and cereal servings by consuming 10 servings per day. However, out of these ten servings per day, only one was a whole grain food. The intake centered on refined and processed snack foods, breakfast cereals, chips, and crackers.
- Americans consumed 34 teaspoons of added sugars per day. This is a 30% higher intake than what was previously reported in the 1988 survey.
- Young children and adolescents have decreased their consumption of milk by 16% since 1970, increased their consumption of soda by 16%, and increased their intake of sugary fruit flavored drinks by 280%.
- The most common sources of foods eaten away from the home are from fast food places. TOP
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New Food Guide Pyramid
by Walter Willet
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This New Food Guide Pyramid, published by Dr. Walter Willet may help teens better understand healthy choices. A visual representation may guide them to the importance of balance and variety among the different foods available. The important issue is to begin to place the responsibility of choosing foods into the teens' own hands, which ultimately will be carried through adulthood.
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