As a consultant paediatric diabetologist at Imperial College London Diabetes Centre in the UAE, I specialise in the health and wellness of children. Therefore, it won’t come as a surprise that my recommendations for a healthy nation focus on mothers, babies, children and youth.
Worldwide, more and more children are showing a tendency towards being overweight or even obese, and research suggests that an overweight child could face an extra struggle with weight issues in adulthood. In turn, excess weight, with a high body mass index (BMI) – often the result of an unbalanced diet and a lack of regular exercise – can manifest as type 2 diabetes. This is the diabetes that is often linked to an unhealthy lifestyle.
Recent figures from the International Diabetes Federation's Diabetes Atlas 2014 suggests that about 19 per cent of the UAE population is living with diabetes, with more than half unaware that they are living with the condition.
Type 1 and type 2 diabetes defined
Type 1 diabetes is an autoimmune condition in which the pancreas is attacked by autoantibodies – antibodies that mistakenly target and damage specific tissues or organs of the body – causing it to fail.
Affecting approximately 5 per cent of the diabetes population worldwide, type 1 diabetes usually develops before adulthood and remains with the individual throughout their life. It is sometimes also called childhood diabetes.
The medical profession is able to explain the bodily process for the condition, but is yet to discover what triggers type 1 diabetes. However, as a result of many factors, including enhanced public awareness of the symptoms, it seems that parents are more alert as to what to look for and are responding by bringing their children in for check-ups. We are now more aware of children living with type 1 diabetes because they are coming to see us much earlier.
Type 2 diabetes, on the other hand, is mainly brought on by an unhealthy, inactive lifestyle, excessive weight gain and genetic predispositions.
Obesity increases the risk of developing type 2 diabetes in adulthood, and with the rise in childhood obesity in recent years, more children are developing type 2 diabetes. Recent statistics show that 10 per cent of children and adolescents suffer from obesity worldwide.
Type 2 diabetes is preventable if caught early and can be avoided, managed and even reversed in children, youth and adults if a healthy lifestyle is adopted and maintained.
Specialist care during pregnancy
It is very important that women take good care of their health before becoming pregnant as well as during the pregnancy. One way to do this is by being mindful of body weight – ideally, becoming pregnant while holding a normal body weight and maintaining a natural, paced weight gain as the baby grows.
Carrying excess weight before or after conception can greatly increase a mother’s risk of gestational diabetes. In turn, an overweight mother places the baby at increased risk of developing diabetes at a later stage. This also raises the risk of complications before, during and after birth, such as a heavy birth weight, breathing difficulties and even heart defects.
Gestational diabetes shows up as “classic” diabetes symptoms such as frequent urination, being very thirsty and even weight loss. But, like type 1 and type 2 diabetes, the symptoms can be masked and go undetected for some time. Therefore, it is crucial that mothers-to-be are regularly screened for diabetes and work with specialists to manage their weight and follow a healthy lifestyle.
Family guidance during the early learning years (0 to 5)
It is important that following the birth of the child, mothers are given access to, and encouraged to attend, regular postnatal classes. This way the mother and baby, as well as young siblings, can be monitored by experts as they adapt and grow.
Mothers should be encouraged to breastfeed their newborn, because breast milk is known to contain properties that protect against diabetes. They should also be offered guidance on how to safely reduce post-baby body weight and provide a balanced diet, as well as be given information on safe exercise opportunities for themselves and their growing family.
It is never too soon to introduce young minds to a healthy lifestyle practice. The early learning years, especially from 2 to 5, are known to really empower the child with knowledge they can carry through life. Working alongside the mother, father and other carers, this is an ideal time to introduce children to the story of food – where it comes from, what is good and why – as well as to encourage an enjoyment of exercise and sport.
Educating children during school years (5 to 16)
School is a perfect place for inquisitive, active, excited, growing young minds and bodies to delve deeper into the attributes of a healthy lifestyle by ensuring that nutrition educators are partnered with schools nationwide.
Working closely alongside the sport and physical education (PE) departments – which ideally will be offering each child at least two PE lessons a week – the educator’s role is to inform and show how a healthy lifestyle means embracing a balanced diet and regular exercise.
Many schools are already monitoring BMI using a method designed specifically for children. This is a great conversation starter to promote knowledge on body weight, obesity, the attributes of a healthy lifestyle and recognising the often subtle signs of diabetes.
Parents and carers need to be aware of the food groups, what constitutes healthy portions and how to make informed choices when it comes to shopping and cooking, but it is equally vital that food providers in schools, teachers and staff understand the importance of a balanced diet and regular exercise. As role models, parents and teachers should set good examples. They can also be taught to recognise an overweight or obese student or colleague, as well as the symptoms of diabetes.
I have often heard mothers say: “I do my very best at home, but then the same message isn’t being given at school.” A healthy lifestyle has to be a priority for everyone involved – children, parents, carers and schools.
Being there for young adults (16 to 24)
When it comes to young adults, it is often tricky for parents to assert their influence. This is when it is important that the corporate and public community – colleges, universities and workplaces – pay attention to the well-being and lifestyle practices of these youngsters.
As a child becomes a teenager and then a youth, a host of external influences come into effect. Pocket money and allowances offer a degree of financial independence, then there’s peer pressure, socialising and changes to routines and lifestyles – fast food, sodas, late nights, parties and so on come into play. Often, this age group gives up the physical activities and sports practised during school years and focuses instead on studying for high-pressure examinations, friends and social gatherings.
There are a number of ways universities and organisations can help, including ensuring that:
• Canteens and cafes serve only healthy, balanced and tasty meals.
• Team sports and competitions are part of the curriculum and/or work activities.
• There is a focus on health and wellness, with complementary lessons and/or meetings.
• There is awareness about the causes and symptoms of diabetes.
Prevention is better than cure
I place tremendous importance on the value of prevention. Prevention activities take a wide range of forms. For example, engaging young girls and mothers in discussions about positive self-image – how it contributes to healthy eating and exercise habits; how to manage peer pressure; preparing for motherhood etc.
We can also use simple tools to measure our own progress in adopting healthy lifestyles. Look at body weight as one barometer for health and wellness, then measure BMI, which is a good indicator of whether your weight is appropriate for your height. Generally, the higher your BMI, the greater your risk of a range of medical problems, including diabetes (see BMI chart). Pregnant or breastfeeding women should not use this method of calculation. BMI charts are usually calculated for adults only, although separate charts are available for children.
Lastly, if you or a member of your family has diabetes or is experiencing some of its symptoms – get screened. Medical screenings for diabetes have become more widely accessible and are conducted safely and swiftly.
I always like to remind the community that each of us has the ability to manage our health. With regular screenings and active prevention, diabetes can be managed, prevented and, in some cases, even reversed.