population-based sample, approximately 60 percent of obese children aged 5 to 10 years had at least one physiological cardiovascular disease (CVD) risk factor—such as elevated total cholesterol, triglycerides, insulin, or blood pressure—and 25 percent had two or more CVD risk factors (Freedman et al., 1999).

The increasing incidence of type 2 diabetes in young children (previously known as adult onset diabetes) is particularly startling. For individuals born in the United States in 2000, the lifetime risk of being diagnosed with diabetes at some point in their lives is estimated at 30 percent for boys and 40 percent for girls if obesity rates level off (Narayan et al., 2003).2 The estimated lifetime risk for developing diabetes is even higher among ethnic minority groups at birth and at all ages (Narayan et al., 2003). Type 2 diabetes is rapidly becoming a disease of children and adolescents. In case reports limited to the 1990s, type 2 diabetes accounted for 8 to 45 percent of all new childhood cases of diabetes—in contrast with fewer than 4 percent before the 1990s (Fagot-Campagna et al., 2000). Young people are also at risk of developing serious psychosocial burdens related to being obese in a society that stigmatizes this condition, often fostering shame, self-blame, and low self-esteem that may impair academic and social functioning and carry into adulthood (Schwartz and Puhl, 2003).

The growing obesity epidemic in children, and in adults, affects not only the individual’s physical and mental health but carries substantial direct and indirect costs for the nation’s economy as discrimination, economic disenfranchisement, lost productivity, disability, morbidity, and premature death take their tolls (Seidell, 1998). States and communities are obliged to divert resources to prevention and treatment, and the national health-care system is burdened with the co-morbidities of obesity such as type 2 diabetes, hypertension, CVD, osteoarthritis, and cancer (Ebbeling et al., 2002).

The obesity epidemic may reduce overall adult life expectancy (Fontaine et al., 2003) because it increases lifetime risk for type 2 diabetes and other serious chronic disease conditions (Narayan et al., 2003), thereby potentially reversing the positive trend achieved with the reduction of infectious diseases over the past century. The great advances of genetics and other biomedical discoveries could be more than offset by the burden of illness, disability, and death caused by too many people eating too much and moving too little over their lifetimes.


These projections are based on data on the lifetime risk of diagnosed diabetes and do not account for undiagnosed cases. The data do not allow for differentiation between type 1 and type 2 diabetes. However, the major form of diabetes in the U.S. population is type 2, which accounts for an estimated 95 percent of diabetes cases (Narayan et al., 2003).

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