Re: Obesity in adolescence

Dear Editor:

I enjoyed the review of management of obesity in adolescence (Paediatr Child Health 1998;3:395–8). I have become involved more intensively with this clinical problem in the past decade because it is the most important risk factor for type 2 diabetes in aboriginal youth (1–3).

I note in Table 1 of your article that abnormal glucose metabolism is listed as a health consequence of obesity. In Canada and the United States, we need to include type 2 diabetes as a significant consequence of obesity in youth at risk. In the Cree communities of northern Manitoba, the prevalence of type 2 diabetes in children age five to 19 years is 1.1%, and the age/sex-specific prevalence is 4% in adolescent females. The prevalence of obesity is 45% in females and 55% in males.

I write this letter to help raise awareness of this growing problem, particularly among our paediatric colleagues. Because most of the youth with type 2 diabetes are asymptomatic, screening of fasting plasma glucose is essential. Clinical practice guidelines for the care of diabetes in Canada (4) recommend annual screening of fasting plasma glucose in persons at risk “at an earlier age” than 45 years. We have recommended screening over age six years based on our experience in Manitoba. Many organizations, such as the American Diabetic Association (Alexandria, Virginia), the Canadian Diabetic Association (Toronto, Ontario), Centers for Disease Control and Prevention (Atlanta, Georgia), National Institutes of Health (Bethesda, Maryland), Canadian Paediatric Society (Ottawa, Ontario), American Academy of Pediatrics (Elk Grove Village, Illinois) and American Pediatric Society (The Woodlands, Texas), are actively engaged in consultation regarding this problem in hispanic, black and native children. The next decade of research will provide better data from which we can make evidence-based recommendations.