 Pre-diabetes is not just a high-risk state for the development of diabetes. Pre-diabetes can be a disease in itself. People with pre-diabetes may already have damage to their eyes, kidneys, blood vessels, and heart. Evidence from numerous studies suggest that the chronic complications of top 2 diabetes start to develop during the pre-diabetic state. So by the time we have pre-diabetes, it may already be too late to prevent organ damage, so best to prevent pre-diabetes in the first place, and the earlier, the better. 30 years ago, virtually all diabetes in young individuals was thought to be autoimmune type 1 diabetes. But since the mid-90s, we started seeing an increase in type 2 diabetes among our youth, particularly in the United States. Indeed, the term adult onset diabetes has now been scrapped and replaced with type 2, because children as young as 8 are now developing the disease, and the effects can be devastating. A 15-year follow-up of children diagnosed with type 2 diabetes found an alarming rate in young adults of blindness, amputation, kidney failure, and death in young adulthood. Why the dramatic rise in childhood diabetes? Because of the dramatic rise in childhood obesity. During the past 30 years, the number of children diagnosed as being overweight has increased more than 100%. Once an obese child reaches 6, they're likely to stay that way. And even if they don't, being overweight in our youth predicts adult disease and death regardless of adult body weight, even if we lose it. Being an overweight teen may predict disease risk 55 years later, twice the risk of dying from a heart attack. More cancer, gout, arthritis. In fact, being overweight as a teen was a more powerful predictor of these risks than being overweight in adulthood. This underscores the importance of focusing on preventing childhood obesity. So how do we do it? From the Official American Academy of Pediatrics Clinical Practice Guidelines, the problem appears to be kids eating too much fat and added sugars and not eating enough fruits and vegetables. Doctors at every occasion beginning soon after a child's birth should endeavor to give sound advice regarding nutrition and growth so that obesity and its complications may be curtailed. What might sound advice sound like? Well, the chair of the nutrition department at Loma Linda University published a paper suggesting not eating meat at all might be an effective strategy. Population studies have consistently shown that vegetarians are thinner than comparable non-vegetarians. This is from the largest such study to date. A body mass index of over 30 is considered obese 25 to 30 overweight and under 25 ideal weight. The non-vegetarians were up at 28.8. The average meat eater in the U.S. is significantly overweight. As one gets more and more plant-based, the average BMI drops, but even the average vegetarian in the U.S. is overweight. The only dietary group that was on average ideal weight were those eating strictly plant-based. So that comes out to be about a 33-pound difference between the vegans and the meat-eaters. Vegetarian children grow up not only thinner, but taller. Vegetarian kids grow to be about an inch taller than other kids. Apparently, meat intake is somehow negatively associated with height. I can just hear the Dairy Council now saying, because of all the milk the veggie kids must be drinking, no. The veg kids consume significantly less dairy and much lower animal protein intake overall. Meat intake is apparently associated with growing wider, though, and school-age children in the consumption of animal foods eat dairy or eggs associated with increased risk of overweight. Whereas plant-based equivalents like veggie burgers, veggie dogs, veggie cold cuts were not, and whole plant foods like grains, beans, and nuts were found to be protective. This may be because plant-based diets are low in energy, density high in starch, fiber, and water, which may increase feelings of fullness, and resting energy expenditure, meaning resting metabolic rate. Eating plant-based appears to boost metabolism, so we just kind of burn more calories at rest, even when you're sleeping. However, we're not sure how much the benefits are due to increased consumption of plant foods versus the decreased consumption of meat. Either way, plant-based diets should be encouraged and promoted for optimal health. Local, national, international food policies are warranted to support social marketing messages and to reduce the social, cultural, economic, and political forces that make it difficult to promote such diets. For example, although the advice to consume plant-based diets is sound, questions arise regarding the relative high price of produce. Yes, we can reduce the burden of childhood obesity, prevent the further spread of disease, but we need to ensure that plant foods are affordable and accessible to children of all income levels. Fruits and vegetables may not fit on the dollar menu, but our kids are worth it. Getting diabetes in childhood cuts nearly 20 years of their life. Who among us wouldn't go to the ends of the earth to enable our kids to live 20 years longer?