Supporting weight loss in children: Getting it right

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.

Understanding the child’s world

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.

Click below to start the eLearning module.

When viewing on mobile devices we recommend opening the module in a new window for the best experience. Click the button below to launch the eLearning module in a new window.

Making the most of your team

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.

Don’t forget: The whole team absolutely has to be transmitting the same message, that weight loss is the only option. As soon as someone hints at an alternative option, it’s likely to undermine the family’s commitment to the intervention.
Helping families to implement dietary change

Click below to start the eLearning module.

When viewing on mobile devices we recommend opening the module in a new window for the best experience. Click the button below to launch the eLearning module in a new window.

No weight loss? Troubleshooting

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.

  • Occasionally families are just waiting to be given a drug, so then it’s back to setting expectations, perhaps with the doctor involved.
  • However, there could be an underlying factor, such as bullying at school, of which even the parents had no knowledge.
  • Another factor is that some families have a history of type 2 diabetes and are used to living with it. Therefore the diagnosis may not provide much of an incentive to change the whole family’s lifestyle.
    • You need to stress how much more serious it is to develop diabetes at such a young age, how much longer the child will be living with the condition and the increased risk for developing serious complications. Asking the doctor to speak with them again may help.
Building on a strong start

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.

  • Some children don’t like following other people’s rules and can only do it for a limited period, so it’s important to find a long-term plan that they feel they have ownership of.
  • For some children it’s about compromise to find a solution they will stick to; for others it’s about explicit rules.
  • Factor in the effects of changes like school holidays, which can result in long periods of inactivity and weight gain, so it’s important to build in some activity the children can keep going with lifelong.
  • Bear in mind that high-stress events such as exams and going to university can result in diet and diabetes taking a back seat.

About the expert

Shelley Easter

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.

The challenge of type 2 diabetes in children Risk factors and treatment options

What are the challenges of type 2 diabetes in children and adolescents? We examine the roles that dietetics, surgery and medication can play in improving outcomes.

Image credits: Healthy vs. unhealthy food © beats_/; Paper people © shefkate/Fotolia; Troubleshooting © MH/Fotolia; Building blocks © Gerisima/; Child wiith fruit © Thomas_EyeDesign/