Surging Diabetes and Obesity in Young Persons

YouthFor the health of the U.S. population, this is a bad sign. While healthcare has done well to bringing down the prevalence of high cholesterol in young persons, diabetes and obesity are surging. Hypertension? It’s in between – neither rising nor falling in persons 20 to 44 over the timespan from 2009 to 2020. These insights come from a new study in JAMA, published late yesterday.

Glaring Disparities

The authors of this new study describe stark racial and ethnic disparities:

“Hypertension prevalence in young Black adults was more than two times higher than in all other racial and ethnic groups, with no improvement over the study period. Black adults have high rates of stroke, heart failure, and hypertensive kidney disease, as well as the highest premature cardiovascular mortality rates in the country, in part due to a high burden of hypertension. The etiology of these inequities is multifactorial but likely includes disparities in early-life exposures, access to healthcare, and other factors rooted in structural racism.

“Mexican American young adults and other Hispanic young adults experienced a significance increase in the prevalence of hypertension over the study period. One potential explanation for these trends is that food insecurity is common in these groups, resulting in very high sodium intake. Mexican American adults also experienced a rise in diabetes, which is especially concerning because rates of undiagnosed diabetes are high in this population.”

Young Black and Mexican American adults lived with significantly higher rates of obesity than young White adults.

Daunting Trends in Children and Youth

Looking forward and in younger populations, the outlook is daunting. A recent study in Diabetes Care offers good estimates for the number of children and youth with type 2 diabetes. It is likely to grow from 28,000 in 2017 to at least 48,000 by 2060. But that’s only if the rate of new cases stays constant and the current growth trend stops. Otherwise, we’re on track to see those case numbers rise eight fold, to 220,000.

As this happens, racial and ethnic disparities will grow even wider. Non-hispanic black youth will have the highest prevalence of diabetes if these estimates are correct.

Tying Back to Obesity

All of this ties back to the rising prevalence of obesity. Though it’s popular in some circles to suggest that obesity is not all that harmful, the causal link between obesity and type 2 diabetes is pretty hard to deny. Stephan Guyenet recently explained this in a remarkably thorough conversation with Ezra Klein:

“Type two diabetes risk is exquisitely sensitive to body fatness. We have a number of huge randomized controlled trials in humans showing that if you take people with pre-diabetes, so they have metabolic disturbances suggesting that they’re at a high risk of developing type two diabetes, you put them on a weight loss diet, you can dramatically reduce their risk of progressing to type two diabetes.

“You can even take people who have type two diabetes, and if you get them to lose enough weight, what you will see is that their lean tissues, the fat in their lean tissues will start to clear out, and their type two diabetes will go into remission.

“Major weight loss via bariatric surgery is associated with stunning improvements in health outcomes. You reduce your risk of developing diabetes by like 87%. You reduce your risk of cardiovascular disease by something like 50%, you reduce your risk of developing certain cancers of all cause and mortality. I mean, the effects are huge.”

Distraction and Denial

Frivolous conversations about “Hollywood weight loss” and angry protestations would have us avoid the subject of obesity in children and youth. These are nothing but distractions from a very real medical problem.

Diabetes and obesity are unmistakably rising in young persons. This is bringing unmistakable harm to their lifetime prospects for health and happiness. We must act wisely to reverse this.

Click here for the new study in JAMA, here for the editorial that goes with it, and here for further reporting from the Washington Post. For Guyenet’s conversation with Klein, click here.

Youth, sketch and study by Kuzma Petrov-Vodkin / WikiArt

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March 6, 2023