French philosopher Jean-Jacques Rousseau argued in the 18th century that children shouldn't be considered miniature adults, and doctors have generally agreed—until now. But kids today are developing very adult health problems, from aging arteries to pre-diabetes to hypertension and high cholesterol. And doctors out of necessity are starting to treat them like grown-ups. Consider: From 2002 to 2005, pediatric prescriptions for diabetes drugs rose by more than 100 percent. "Our findings are a symptom of a growing problem in children, the increase in chronic disease," says Emily Cox, senior director of research at Express Scripts, a pharmacy benefit management company in St. Louis, whose study on medication use in children was published in November in Pediatrics.
Safeguarding kids requires getting to the root of the problem—rising rates of childhood obesity. About 18 percent of kids are now obese, compared with 5 percent in the 1970s. In children as well as their parents, excess body weight often leads to increased blood sugar levels, insulin resistance, and eventually to "adult-onset" type 2 diabetes, which now strikes about 3,700 children a year. In severe cases, a child's arteries begin to look like those of a middle-aged person. According to research presented in November at the American Heart Association meeting, ultrasounds of overweight youngsters ages 6 to 19 who had high cholesterol indicated a buildup of plaque comparable to that in a typical 45-year-old. These kids are facing heart attacks in their 20s and 30s, warns Carl Lavie, medical director of cardiac rehabilitation and prevention at Ochsner Heart and Vascular Institute in New Orleans. "It's scary to think that our kids may not live as long as we do," he says.
Recognizing the need for urgent action, the American Academy of Pediatrics last July proclaimed that all overweight children over age 2 should be given a fasting cholesterol test. (Doctors had already been checking blood pressure in all children starting at age 3 and screening overweight kids for diabetes starting at age 10.) To prevent high cholesterol, the AAP says, parents should give even toddlers reduced-fat milk, especially if they're already pudgy. Kids over age 8 who have high levels of "bad" LDL cholesterol (more than 190 mg/dL) should be treated with cholesterol-lowering medications like statins if nutrition and exercise counseling don't work, the AAP says. Those with moderately elevated levels (over 160 mg/dL) and heart disease risk factors like insulin resistance, hypertension, or obesity should also consider drugs. "We have to assume that lowering high cholesterol in kids will prevent future heart attacks in them as adults," argues Frank Greer, a professor of pediatrics at the University of Wisconsin School of Medicine who helped write the guidelines. "We don't have time to wait for the research."
But that lack of data has some experts very worried. "What are the side effects of treating kids from, say, age 10 to age 80?" asks Roseann Spiotta, a clinical instructor of family medicine at Jamaica Hospital in New York who reviewed the guidelines in the November issue of the journal American Fam ily Physician. The U.S. Preventive Services Task Force determined in 2007 that there is "insufficient evidence" to recommend cholesterol screening or cholesterol-lowering therapy in kids (or diabetes or blood pressure screenings, for that matter). The American Heart Association does allow for cholesterol screening in children with a family history of heart disease before age 55, but specifies a low-fat, low-salt diet as treatment.
Gray area. Drugs are clearly necessary for kids with type 2 diabetes and for those with an inherited form of high cholesterol in which LDL levels soar well above 200 mg/dL. But Spiotta thinks the right course of action for an overweight child with somewhat elevated cholesterol and blood sugar levels falls into a "gray area" requiring a talk involving parents, physician, and kid. The wisest move—changing the diet and exercise habits of the entire family—is often the hardest to implement.
For kids who barely tip the scales, simple solutions—like a daily walk or hour of outdoor play and a switch to low-fat dairy products—might do the trick. The easiest calorie saver? Substitute water for sugary sodas and fruit juices, which a June Pediatrics study found accounts for an average of 270 calories a day in kids ages 2 to 19. Establishing set meal times and periodic healthful snacks may also help your child avoid endless dips into the cookie jar. The government's food pyramid guidelines recommend offering kids a variety of fruits, vegetables, low-sugar cereals, and low-fat dairy products with a daily serving or two of meat or beans. They also suggest eating as a family, and using those times to get kids to sample new foods.