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Editor’s Note: In her latest book, Prediabetes: A Complete Guide: Your Lifestyle Reset to Stop Prediabetes and Other Chronic Illnesses (American Diabetes Association, 2018), author Jill Weisenberger, MS, RDN, CDE, CHWC, FAND, provides steps and strategies that will empower clients, patients, and others to make the most healthful eating and lifestyle modifications that work best for them so they can live their best healthful lives. Writing from the standpoint that taking an individualized approach is best for people to prevent type 2 diabetes and other chronic diseases, Weisenberger helps readers identify their risk of developing type 2, set behavioral goals, build motivation, change eating habits for weight loss, incorporate physical activity, and more. She also provides sample recipes and meal plans clients can use as a guide along their journey to better health.

The following excerpt is from the 13th chapter, “When Your Child Is Diagnosed With Prediabetes.” In it, Weisenberger addresses the anxieties and fears parents and guardians may feel when their children are diagnosed with prediabetes. She then outlines 14 steps parents and guardians can take to help their children and themselves take control of the diagnosis and prevent its progression to type 2 diabetes.

The excerpt is written specifically for parents and guardians and therefore serves as a patient education resource that nutrition professionals can use during counseling sessions.

— Judith Riddle, editor

When Your Child Is Diagnosed With Prediabetes

As adults, a diagnosis of prediabetes is likely to evoke some emotion. We might feel fear, worry, or guilt when we learn of this diagnosis. But when it’s our child who has prediabetes, putting him or her at risk for type 2 diabetes, it’s likely that our own emotions are magnified. You may feel panic, guilt, or a heightened sense of urgency. While it is urgent to address your child’s health, keep in mind that even among children and teens with prediabetes, a diagnosis of type 2 diabetes is not inevitable. With careful attention, you, your child, and your child’s health care provider can work to manage this health problem.

14 Steps to Help Your Child with Prediabetes
The risk factors for prediabetes and type 2 diabetes are similar for both children and adults. Likewise, the same healthy lifestyle habits discussed throughout this book will help your child, too. Here’s a bit more guidance specific to helping children. In this chapter, as in the rest of this book, prediabetes refers to pre-type 2 diabetes. Although you are likely to find insight in this chapter if your child has type 1 diabetes, you will need to work closely with a team of health care professionals.

1. Ask your child’s health care provider if your child is overweight. Although overweight and obesity increase the risk of developing prediabetes and type 2 diabetes, not everyone with these diagnoses is overweight. If your child is overweight, ask if the appropriate goal is to maintain weight during growth, slow the rate of weight gain, or to lose weight. Whether or not weight loss is a good idea for a child has to do with several things, including the child’s age, height, and weight.

2. Ask for a referral. Once your child’s health care provider has explained the diagnosis and made some basic recommendations, ask for a referral to a registered dietitian or a registered dietitian nutritionist (RD or RDN). This is the person to help you and other members of your family plan healthful meals and snacks. A skilled RDN will help you and your child set reasonable, actionable goals to help the entire family feel empowered and be successful.

3. Make it a family affair. Even if only one member of the family has health concerns, it’s important for the entire family to live healthfully. This scenario supports your child and helps him or her to prevent feeling isolated or stigmatized. Besides, there’s no member of the family who doesn’t need to eat and live healthfully.

4. Avoid negative language. Take another look at Chapter 11. Just like it’s harmful for you to use negative language when talking about yourself, using negative language is hurtful to your child. Avoid saying things like, “You can’t have chips and cookies.” Try rephrasing the language to something more positive like, “Let’s pick out a couple types of fruit for your lunch this week and leave the cookies for a special occasion.”

5. Give your child choices. If you’ve made it a goal for your family to eat dessert only three times per week, for example, allow your child to choose what or when. You might give your kids the choice of having an ice cream sandwich at the beach this afternoon or waiting until after dinner for a small cupcake.

6. Be supportive, not controlling. Ask your child about changes he or she wants to make. This gives your child an important sense of control. Provide a supportive environment—one without judgment and stigma. Provide healthful food and drink without excessive temptation of unhealthful food choices. Avoid telling your child when he or she has eaten enough. Instead allow your child to learn about individual hunger cues. Provide plenty of opportunities to be active.

7. Make activity fun. Your children may enjoy team sports, martial arts, ballet, or running. As a family, you might like biking, hiking, and swimming. Maybe you can purchase an active game for your gaming console. Whatever you do, focus on fun activities and not punishing activities. Don’t talk about exercise as punishment for eating too much or being overweight. As you read in Chapter 8, exercise has plenty of rewards. And, besides, having a health concern is not a reason to be punished.

8. Model good eating and exercise behaviors. Kids definitely pick up both behaviors and values from their parents. Show them that you value good health by eating wholesome foods and being physically active.

9. Eat more meals at home. And eat them together. Eat at a table, not on the couch while watching TV. If time is tight, here are some tips:

  • Plan fast and simple meals like soup and sandwiches.
  • Combine prepared foods like rotisserie chicken with scratch items like brown rice and broccoli.
  • Bring out your slow cooker to have dinner ready when you are.

10. Include your kids in the meal planning and prep. Dole out tasks that are appropriate for age. Young children can set the table, rinse fruit, and count the proper number of carrots for a recipe. Older children can cut vegetables and use the stove. Make it fun by allowing children to pick recipes or themes. Try out taco night or throw a blanket on the floor and pretend it’s an outdoor picnic.

11. Eliminate—or severely limit—sugar-sweetened beverages. Sugary sodas, teas, fruit drinks, and sports drinks provide a lot of calories and a lot of added sugar. Yet they offer little in the way of nutrition. If you do have them, make them a rarity and keep the serving to approximately 1 cup.

12. Don’t use food to reward or punish. This tactic can have lasting effects, making it hard for your child to have a healthy relationship with food.

13. Enforce a bedtime. Because kids have more activities and more homework, getting to bed on time is a challenge. Yet it’s critical for good health and good decision-making.

14. Be patient. It’s hard for us to make lasting changes. It’s hard for our kids too, especially when they are faced with unhealthful messages in the media and from friends and when there is such an abundance of eating opportunities. Don’t expect perfection. Simply look for opportunities to make smart choices and to teach your children how to make smart choices.

Be Empowered

  • Seek advice from your child’s health care provider. Ask for a referral to a registered dietitian nutritionist.
  • Pick two to five changes to implement. If appropriate, do this collaboratively with your child and other family members.
  • Once you and your family have mastered these initial goals, create a few more.

— Jill Weisenberger, MS, RDN, CDE, CHWC, FAND, is a freelance writer and a nutrition and diabetes consultant to the food industry. She has a private practice in Newport News, Virginia, and is the author of the bestseller Diabetes Weight Loss — Week by Week and the new Prediabetes: A Complete Guide.

Diabetes Care During the School Year

Back-to-school physicals may bring new diagnoses of prediabetes or type 2 diabetes in children. More than a decade ago, the prevalence of prediabetes in the pediatric population was about 16%.1 More recent data show that approximately 18% of children aged 12 to 19 in the United States have prediabetes.2 Much fewer have type 2 diabetes.

Though the new school year comes with hectic schedules, this may be an ideal time for parents and families to reassess habits and behaviors that can dial back insulin resistance, preserve beta-cell function, and stave off type 2 diabetes. With back to school as a fresh start, children and their parents may be open to fresh eating, exercise, and bedtime routines. Dietitians can help families set goals around each of these lifestyle domains.

It will be important to help children find time for exercise between school, homework, and extracurricular activities. Through discussion, RDs can help children find physical activities they enjoy and identify opportunities to engage in these activities. Adequate sleep often is a challenge during the school year but is critical for good health and improved insulin sensitivity. Dietitians can begin this conversation with an explanation of the ways in which sleep affects both physical health and our motivation and focus for self-care behaviors. Neither brown-bagging lunch nor eating a school lunch is a clear better choice. If the family prefers a school lunch, reviewing menus and highlighting the more wholesome options will help children make good choices. Likewise, if the family prefers to pack lunch, creating a few sample menus will be helpful. Other potential obstacles are after-school snacks and food provided at sporting events and after-school activities. Instead of allowing children to grab any snack when they arrive home from school, parents can make two or three choices available from which the children can choose. It’s harder to deal with food provided by other adults such as snacks at soccer practice or club meetings. RDs can empower parents to discuss healthful eating goals with teachers, school administrators, and other parents. The emphasis should be on looking after the health and welfare of all children.

Though a diagnosis of prediabetes may be overwhelming for families, it’s also an opportunity for them to commit to long term healthful lifestyle habits that will benefit each family member.

— JW

1. Pinhas-Hamiel O, Zeitler P. Prediabetes in children and adolescents: what does it mean? Medscape website. https://www.medscape.com/viewarticle/776457_2. Published January 2, 2013.

2. Menke A, Casagrande S, Cowie CC. Prevalence of diabetes in adolescents aged 12 to 19 years in the United States, 2005-2014. JAMA. 2016;316(3):344-345.