Obesity is a major driver of type 2 diabetes in children, and, as shown in adults in the DiRECT trial, successful weight loss can send diabetes into remission.
Weight management is therefore a cornerstone of care for children and adolescents with type 2 diabetes. Find out more about its complexities and learn tips and tricks for success in this interactive guide, written in consultation with specialist pediatric dietitian Shelley Easter, from the Bristol Royal Hospital for Children in the UK.
If a child is diagnosed with type 2 diabetes in the UK, then the foundation stones will have been laid and expectations set during the process of diagnosis: the family will be aware that weight loss is the treatment and be ready to receive support to that end.
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Judicious use of team members can help to get the best results, whether you have access to a large multidisciplinary team or just a doctor, nurse, and dietitian.
But there may be some pitfalls to avoid as well as benefits to be gained.
So team members may need to be prepared to take on certain elements of each other’s roles on occasion, and to support each other to do so. Where possible, specialists such as psychologists should be involved right from the start, so they are viewed as part of the standard support package.
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In almost all cases, an absence of weight loss indicates that not everyone is on board with the plan. Either one or both parents, or other caregivers, are following different procedures, or the child or young person themself is obtaining extra food without their caregivers’ knowledge.
With the support of a pediatric dietitian, you can try a more structured dietary approach, such as a calorie-controlled plan. If a teenager has a school holiday approaching, you could also consider giving them a rapid weight-loss boost with the short-term use of a meal-replacement plan, when it can be done at home without any social acceptance issues.
Then it’s time for some in-depth conversation to find out what is (or isn’t) happening at home to prevent weight loss. Be open and say you would have expected weight loss by now, and ask what it is that’s not working, but without being too challenging. Consider talking to the parents without the child involved, and with the psychologist involved. Perhaps the family can talk to a team member they haven’t previously spoken to as much.
After the initial intensive input from the healthcare team and successful weight loss, the focus can slacken and the weight loss plateau or reverse. So it’s important to work on a healthy lifestyle plan for long-term weight maintenance.
Shelley Easter has worked at the Bristol Royal Hospital for Children for 17 years. She is the Regional Specialist Paediatric Dietitian for weight management and is part of the newly established Complications of Excess Weight (CEW) hub service for the Southwest of England. Prior to this she was the lead Paediatric Dietitian for diabetes and weight management.
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