Well, we are at the end of Diabetes Awareness Month. However, the need to remain vigilant for the risks continues past this month. There are numerous challenges to preventing diabetes. We all are experiencing the stresses of living during a pandemic with all the accompanying changes to our lives. It is well known that individuals have been eating far more comfort food and adding weight during this time period. Obesity is a major risk factor for diabetes both in adults and youth. Obesity has multiple causes ranging from genetics to lifestyle. However, stress can play a large role in obesity in youth (children and teens). Recent estimates from the National Health and Nutrition Examination Survey as well as the Center for Disease Control (CDC) indicate that approximately one-third of children in the United States are overweight or obese, with approximately 17-20% meeting criteria for obesity. A recent national longitudinal study in the US indicated that 12.4% of children in kindergarten were obese and another 14.9% overweight; overweight 5-year-olds were four times more likely than normal weight children to become obese later in childhood at age 14. Obesity is a risk factor for the rise in Type 2 diabetes in the young. In the United States, while 29.1 million people are living with diagnosed diabetes, about 208,000 people younger than 20 years are living with diagnosed diabetes. Rates are rising for increased incidence of diabetes in the young.
Stressors can be physiological or psychosocial, such as stress in children, in the family, or in the parents. Physiologically, stress affects primarily the hypothalamic-pituitary-adrenal (HPA) axis and affects such hormones as cortisol, insulin, leptin, ghrelin, serotonin, and catecholamines such as adrenaline, noradrenaline, and dopamine. Psychosocial effects can lead to anxiety/depression and disordered eating behaviors such as emotional and distracted eating, a sedentary lifestyle, and poor sleep. In fact, poor sleep as a factor is associated on its own with incidence of childhood obesity. Perceived stress in the young has been linked to emotional eating. Higher levels of perceived stress have been found to be associated with a larger waist circumference and body mass index, all associated with obesity.
It is clear that young people experience and report significant levels of stress. This was true even before the start of the pandemic earlier this year. In a survey of teen stress concluded before the pandemic, the American Psychological Association found some striking results. Teens worry most about school (83%), getting into a good college (69%), and financial concerns for their families (65%). Many teens state they lie awake at night (35%), feel irritable or angry (40%), or feel overwhelmned by stress during the past month (31%). In that survey, many teens reported that they were curt or snapped at schoolmates (26%) in the past month and 51% of teens noted that others told them they appeared stressed during the last month. Findings are more mixed regarding parental stress and youth weight. There have been some studies linking parents’ perception of their stress to increased fast food consumption in their children but other studies have failed to replicate that finding. In a more recent survey of 1,000 teenagers from the mental health initiative WellBeings.org from October 2020, the findings were bleak. Almost 50 percent of teens said their mental health is much worse or somewhat worse than it was pre-pandemic. More than 50 percent said their social life is worse or somewhat worse, and over 72 percent said that the coronavirus has created a disadvantage for their generation, with climate change and racial strife cited as the biggest societal stressors for them outside of the virus. .Of course, within the family, stress can come from financial strain, the family’s structure, or changes in physical or mental health of family members.
So what can parents do to help youth manage the stress which can lead to obesity and increase the risk for diabetes? Here are some ideas:
1. Help children increase fruit and vegetable intake. Serve fruit with breakfast and offer fruit and/or vegetables as snacks. Include side salads with dinner and encourage fruit as a dessert.
2. Get proper exercise. Exercise can decrease cortisol and trigger release of chemicals that relieve pain and improve mood. It can also help speed metabolism burn off whatever has been eaten.
3. Engage in stress reduction strategies. These can include yoga, meditation, mindfulness, or progressive muscle relaxation. Yes, these can be used with youth. All of these strategies encourage a focus on the immediate reality, help pay better attention to your physical self, and reduce worry and anxiety. I’m fond of using the 4-2-4-2 approach. Inhale through the nose for 4 seconds, hold it for 2 seconds, slowly exhale out the mouth for 4 seconds, hold that state for 2 seconds, repeat as necessary. It really works. I have used it to successfully obtain a quick relaxation response with many patients.
4. Get proper rest and sleep. Avoid overeating in the evening, consuming stimulating beverages, and use stress reduction strategies as discussed above. Children and teens need more sleep than adults and often do not obtain it. Recommendations have been on average for children to sleep up to 10 hours per night while teens can benefit from 8-9 hours per night.
5. Be more aware of what you are eating. Help your young person (as well as yourself) consider when about to eat something whether they actually are hungry or whether a distraction such as television is contributing to the distracted eating. This sometimes is referred to as mindful eating. Pay attention to what you are eating, slow down eating, attend to the feelings of fullness, and avoid emotional overeating. One way to reduce emotional overeating has been to focus on the future rather than on the present when inclined to eat comfort foods. Research has shown that when focusing on the future people make healthier choices in foods.
6. Find Rewarding Activities Unrelated to Food. Take a walk with your young person socially distanced from others, read a book to them if they are of an age to enjoy that, help them increase their socialization with family and friends even through Zoom calls and others technologies. These can help relieve stress without overeating. Some may say that they don't have time with all their stressors. Making and taking the time to do so will help your young person relieve stress, think more clearly, feel happier, and be less likely to overeat.
7. Check your young person for proper mindset. As I always say, become more aware of what you say to yourself about yourself. If your child or teen has too many thoughts like "I can't handle my stresses", "I'm overwhelmned", "I'll never get out from what is stressing me", then it's time to help them with a mindset do-over. Gently challenge the above thoughts and remind them how many times they in fact have handled stressors. Remember that help is available in many forms. Keeping negative thoughts in mind also will result in your reaching for "comfort foods" with all the additional problems that will cause.
If you want more information about stress management, please access our book (I Can’t Take It Anymore; How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D. and Janice B. Longobardi, R.N., B.S.N., P.H.N.), available on Amazon at https://www.amazon.com/dp/1542458056. If you want more information about the authors, book, or other stress information, please visit our website at www.manageyourhealthandstress.com.
Good luck on your journey.
Dr. Paul Longobardi
For information on these and related topics, please visit my website at www.successandmindset.com