The number of teens with youth-onset type-2 diabetes is projected to quadruple in the U.S. by 2050 if adequate interventions are not made, according to Diabetes Care, a medical journal. Excessive body weight is a leading risk factor for diabetes and Oklahoma is ranked number three in the country for having it, as stated in Healthy Americans, a health research organization.
Having extra weight is more than an aesthetic concern, especially for young people. Being overweight puts teenagers at risk for chronic health conditions, including depression, high blood pressure and youth-onset type-2 diabetes–the most debilitating obesity related condition. According to Diabetes Care, type-2 diabetes in youth, though rarer, is more aggressive and less responsive to treatment than with adults. This impending epidemic is preventable with a response from schools and health care providers.
One Tulsa teen, Briana Riggs, received the life changing diagnosis of type-2 diabetes last year, less than a week before her 14th birthday. Riggs and her mother, Crystal Kite, found there is a lack of education and resources for this disease in Tulsa. Kite described how isolated and powerless she feels some days. There are no support groups for these teens or their parents, and no discounts for medication.
“Every corner I’m taking, I’m running into “oh she’s not 18…. She’s not 18’. That’s stupid, if anything, people under 18 need it more than the working adults.” says Kite. “It just seems like the healthcare system has gotten pretty stupid over the diabetic thing.”
Very little research is out there on youth-onset type-2 diabetes since it only emerged in the last three decades, according to Diabetes Care. It was not considered a pediatric disease until recently. Teenagers of Black, Indigenous, Hispanic, Latin and Pacific Islander origins are being affected the most. Teenagers of low-income families, making less than $15,000 a year, are also developing it at a higher rate. That is less than the estimated $19,736 it costs yearly to treat type-2 diabetes, according to the American Diabetes Association.
Francisca Trujillo, a physician’s assistant, diabetes specialist and founder of the Trujillo Multi-Healthcare Medical Clinic, is concerned about the number of children she is diagnosing with prediabetes in Tulsa. One child was only eight years old.
Trujillo Medical is a general medicine clinic specializing in diabetes care in the Tulsa community. Photo provided.
“It’s sad…by the time they hit their teens, they’re gonna have diabetes,” says Trujillo. “They’re gonna be living with diabetes if the appropriate interventions are not done.” She explained that being a minority and being obese are the biggest risk factors.
According to Stanford Children, a children’s hospital, overweight and obese children can suffer low self-esteem because they may be judged as “lazy or weak-willed” due to their size. This affects their social lives and emotional health.
Dr. Andre Fredieu, a neurologist who is medical director of the Oklahoma Stroke and Neurological Institute at Hillcrest Medical Center, describes the health impacts of youth obesity: “Obesity leads to a greater stress on all of your organ systems. So your heart is working harder at a younger age. Your kidneys are working harder at an earlier age. Your liver is working harder at an earlier age. So you know, I think that in our young community, obesity is probably our biggest medical issue. Because that leads to hypertension at an earlier age. It leads to diabetes at an earlier age. And once you get those medical conditions, the earlier you get them, the harder it is to manage them. The harder it is for the access of care, you know, if you’re 18 years old and you’re morbidly obese and you have hypertension and diabetes, and you have limitations to access of care, then what is really gonna be your quality of life?”
About a third, or 32.3 percent, of Oklahoma’s children ages 10-17 are overweight or obese, according to Oklahoma State Department of Health.This is almost double what it was 10 years ago. In 2019, 20.3 percent of Oklahoma’s children got the recommended amount of fruits and 9.4 percent got the recommended amount of vegetables.
Physicians diagnose someone overweight or obese by using a formula to calculate the amount of excess body fat, called a Body Mass Index (BMI.) Since BMI is using a specific height and weight on a case-by-case basis, there is no clear-cut answer in pounds for what is overweight versus obese. According to the University of Rochester Medical Center, neither BMI nor weight are a single indicator of health.
Trujillo also explained how you can be underweight and develop type-2 diabetes. And being overweight does not mean you will for sure develop it. It just increases the risk.
Youth-onset Type-2 diabetes is a glucose processing disorder, according to Mayo Clinic. Glucose (sugars) are what allow your body to get energy from foods. The sugars build up in your blood when your body cannot receive the energy properly and starts to damage your body. The most common symptoms are increased hunger, thirst and urination, Trujillo says. A lot of patients end up finding they have it after being seen for seemingly unrelated health problems, like urinary tract infections (UTIs.) Another common sign is unexplained weight loss.
Teenage obesity and type-2 diabetes have many causes. Researchers used to only look at genetic predispositions and individual lifestyle choices (food and exercise.) Now they are uncovering that those causes are not impacting health as much as the “social deterrents: income, education, housing/neighborhood context and access to healthcare and nutritious foods,” according to a study in Diabetes Care. The study went even further to say that individual and family lifestyle interventions may not be enough to stop this forthcoming epidemic. Lifestyle interventions do matter but cannot be the only action being taken.
The contributing component in Tulsa to adolescent obesity and type-2 diabetes is the segregated geographical layout of the city. The south, and predominantly white, side of Tulsa has greater and disproportionate access to healthy grocery stores, gyms, parks, and healthcare facilities compared to the north and east side. It is no coincidence that the north side of Tulsa is home to mostly communities of color. Worldwide, low-income families and minorities are facing these same health inequities due to systematic racism and poverty.
Reggie Ivey, associate director of the Tulsa Health Department who has worked there for 29 years, says several years ago health officials recognized that “racism is a public health issue.” In light of that, they created the Health Equity Office, an innovative program that addresses the specific needs of North Tulsans. The Health Equity Office hosts a yearly conference where national experts talk about how racism impacts health, neighborhoods, transportation, and employment.” “We’re calling out racism in a big way,” says Ivey.
The racial health inequalities of Tulsa teens come as a direct result of who is elected and paid to represent their best interest. Ivey talks about how there is a lot the community can do, especially since we are in an election cycle nationally, and locally.
“We need the community to really look at the record of those who are running… We often times vote party line and that sort of thing, but when you look at the record of how a person has behaved in their career… It tells a story. And so, it’s important for the community to make sure that you vote for someone that is going to work on your interests,” says Ivey.
The federal and state governments fail to make policies that make medication for teenagers with diabetes affordable, Ivey, other health officials, and providers say. There is a failure at all levels of government to enforce programs and laws that increase healthier lifestyle opportunities and environments for minority populations. Very little policy, incentives and funding are available to reduce childhood obesity, especially among minority populations and teens,
The state government’s policies have contributed to teen obesity and type-2 diabetes, critics say. State curriculum standards that lessen or eliminate requirements for physical education and cutting school lunches have increased the already existing levels of childhood food insecurity. Dr. Fredieu says the city of Tulsa has turned its back to the needs and quality of life of half of the residents, the non-white ones.
Access to healthy food in North Tulsa is the most blatant contributor to excessive weight gain for teenagers and type-2 in Tulsa, according to some health providers. “North Tulsa is a food desert. There’s really only one grocery store in North Tulsa, and that’s Oasis grocery store,” says Dr. Fredieu. “You know, when you drive into South Tulsa, or other places, you’ll see a Reasor’s grocery store every 5 to 6 miles. So, when you have a people that are not being educated on their risk factors, and then you don’t give them the basic necessities for them to be able to eat healthy, and live a healthier life, that’s going to adversely affect your lifespan.”
Poor nutritional standards in Oklahoma schools are also contributing to weight struggles and type-2 diabetes. Coach Derek Brown, a recently retired physical education teacher, talks about how they would serve pizza every day at school. “I don’t know why, but that in itself was counterproductive to a healthy lifestyle.”
Ivey, of the Tulsa Health Department, says the program created by the Tulsa Health Department 15 years ago called It’s All About Kids, that teaches children and teens about fitness and nutrition. Created to address issues surrounding weight, the young people learn about the nutritional value of foods, reading food labels and encouraging them to exercise.
The program is also responsible for providing a healthier menu for school lunch by working with a nutritionist. Now children have the option of salads. “We monitor students over a period of time and it has worked in reducing excessive weight gain among the students that participate in the program,” says Ivey. They are only reaching about 20 percent of TPS children because of lack of funding. About 75 percent of Tulsa Public School System students qualify for lower or no cost meals.
Riggs, the 15-year-old diabetic, speaks to this issue as well, saying that at her school in Tulsa, they have salad bars, but if you’re not among the first in line, the salad runs out. She thinks that students like her, with health conditions that make it important to eat healthier, should be allowed to go first.
Food insecurity exacerbates chronic illnesses like diabetes and obesity, according to Hunger Free Oklahoma, a non-profit organization. Oklahoma has the third highest percentage of food insecure people in the nation, according to State of Childhood Obesity. More than 1 in 5 children in the state do not get enough food, and hardly any nutritious food.
Another outrageous cause for weight gain in teenagers and type-2 diabetes is the fact that Oklahoma is a “Fast Food Testing Market,” says Ivey. Fast food restaurant chains want to be sure that they will profit from any new products or recipes before they introduce them to the masses, so they test it in certain cities first. Tulsa is a designated junk-food guinea pig.
Most of Tulsa is not a walkable city, even on the south side. The north side is underdeveloped and there are few gyms, parks and walking/biking paths. What we are surrounded by influences what we do. The environment makes a difference to whether we get outside and move.
The U.S. Department of Health and Human Services recommends 60 minutes a day in physical activity for all grades. Each school district in Oklahoma is permitted to enforce its own rules on this. It is also up to the discretion of each school district whether they are allowed to take away recess and P.E. as a form of punishment. Decreasing the amount of physical activity at schools is not beneficial to the well-being of students, or teachers. It also increases disciplinary behavior in young people.
Teenagers today are living in a different world than the older generations. “Before the advancement of technology, you know, we were outside playing. It was just normal to go outside to play…they’re not outside playing basketball as much, or football, or anything,” says Brown.
Brown talks about one thing he thinks the curriculum is missing, something he learned from his mother, “She was a nurse educator. And it’s called, basically, holistic health. Holistic Health, the concept that everything is connected. The concept of physical health, emotional health, spiritual health, mental health, they’re all tied together. And that’s something that I wish we would include more of in our curriculum.”
Trujillo, the physician’s assistant, says environment and family play huge roles. “Something else that contributes is the lifestyle we have been raised in, and it can affect the environment we provide for our children. So if we as adults grew up in a family or environment where we did not exercise much or were consuming high amounts of sugary drinks, that tends to be normalized. Those types of behaviors are usually duplicated or replicated whenever the children have their own. It kind of trickles down to the children, and that is how generational obesity can occur, and increased risk of diabetes.”
For Kite and her daughter, Briana Riggs, they say they are waiting for change. “We’re just kind of in limbo right now. And just as a mom, I hope and I pray that when she does become a younger adult that she can overcome it.”
Additional Resources
Online
Child/Teen BMI calculator (not intended to replace seeing a doctor: )
Elected officials voting records
Based in Tulsa
Trujillo Multi health care Center
(Educational Classes will be held in mid September)
Tulsa Health Department
Editors note: In our commitment to fostering a more inclusive and compassionate dialogue, we have chosen to revise the title of this article to reflect a sensitivity to the diverse experiences surrounding weight and health. The term “obesity,” while clinical, can carry stigmatizing connotations that may alienate or hurt individuals facing these challenges.