Chronic Disease in Teens

Health problems in the fast-food generation

Ideally the teen years are a time of perfect health, without the illnesses that can affect older people. Unfortunately, there are chronic diseases (those that persist for a long time) that can affect teens. Sadly, too, many are the result of our modern but sedentary lifestyle. Understanding and recognizing those diseases will help in their treatment and in some cases, prevent their onset.

Obesity

Obesity is a dangerous condition becoming more and more common in our culture. It is developing into a serious crisis in the teen population. The number of obese teenagers (aged 12 to 19 years) increased from 10.5 to 15.5 per cent between 1988 and 2000. Obesity poses a threat to overall health, and is linked to heart disease, high blood pressure, Type 2 diabetes, and even some cancers.

Overweight adolescents and their parents must understand this is more than a cosmetic issue. Excess weight can have a long-term effect on your adult life and health.

Obesity as a chronic health problem has received more attention lately. Lawsuits have recently been filed against major fast food corporations serving high fat foods. On average, urban kids under the age of 17 visit fast food restaurants twice a week. Quick service, convenience, good taste and inexpensive prices are appealing to adolescents. Teens can afford to eat and socialize at these places. However, eating fast food too often can lead to rapid weight gain.

Part of growing up and becoming more independent involves making food choices on your own. With school, hobbies and after-school jobs, teens may spend a lot of time away from home. Still, it is important to eat on a regular schedule. It is thought that up to half of teens skip breakfast. Without breakfast, it is hard to stay awake and concentrate in school. Total nutrient intakes are lower in adolescents who miss breakfast. Breakfast may be skipped in a misguided attempt to reduce calories. Overeating at the next meal or snacking on high calorie and fat foods is often the result. What’s more, kids who eat at least two consistent meals a day are leaner than those who do not. Those who eat more family meals also tend to be a normal weight and have better overall nutrition.

The teen years are a time for learning to make wise food decisions. If poor eating habits are formed now, it is very difficult to acquire better habits later. Those who eat badly during adolescence risk obesity later in life. If eating well is unfamiliar and difficult for you, get one-on-one help by talking to a dietitian.

High Blood Pressure

Evidence suggests that having high blood pressure in childhood is linked to high blood pressure as an adult. The condition is also genetic (inherited). It can lead to an increased risk of strokes, heart attacks or heart failure, as well as kidney disease. High blood pressure may have no symptoms. Severe cases may involve chest pain, headaches and blurred vision.

Body size is the biggest predictor of high blood pressure in children. About half of children with high blood pressure are very overweight. Losing weight can improve blood pressure. Girls with this condition who are on birth control pills must be monitored, since the pill tends to make it worse. Drinking alcohol and smoking can also increase blood pressure.

Finding out if you have high blood pressure involves taking a reading. Normal blood pressure shows a systolic (top) number less than 130 and a diastolic (bottom) number less than 80. To be sure of a true reading, blood pressure should be properly checked at least twice at two or more doctor’s visits. Some people have ‘white coat anxiety hypertension’ – since they are nervous at the doctor’s office, their blood pressure goes up. After they have met the doctor more than once, their blood pressure reading lowers.

Diabetes

Diabetes is also becoming more common in teenagers. Almost all kids with this disease initially have Type 1. Generally, those with Type 1 diabetes are not overweight. Early symptoms of the disease involve weight loss, frequent passing of urine and increased thirst. These symptoms may be linked to the destruction of insulin-producing pancreas cells by the immune (defence) system.

Until recently, Type 2 diabetes was thought of as an adult form of the disease. However, up to eight per cent of kids with diabetes now have Type 2. This version involves the cells of the body becoming resistant to insulin. Most kids with Type 2 diabetes are overweight or obese when diagnosed. They tend to be over the age of ten, often in the mid- to late teen years. Symptoms may include some glucose in the urine, mild symptoms of thirst or increasing passing of urine. There may be no symptoms. Usually a family history of Type 2 diabetes exists. This type of diabetes is also treated by diet and weight loss, and has the potential to be cured by weight loss.

In all three of these chronic diseases – obesity, high blood pressure and diabetes – excess weight plays a key role. In some cases, lifestyle changes alone may provide a cure. If there is one vital message, it is that these changes are much easier to make before health problems arise. As the old saying goes, an ounce of prevention is worth a pound of cure.

Asthma

Some chronic illnesses are more difficult to avoid, even if the guidelines for weight and exercise are followed. More kids see their family doctors for respiratory problems than any other problem. Respiratory problems are usually related to viral infections that improve and resolve. Some teens do develop chronic respiratory diseases, the most common being asthma. In fact, asthma is the most common chronic illness affecting children and adolescents today, with about 4.8 million sharing the disease.

Inflammation and spasm in the airway cause asthma. In your body, particles called inflammatory mediators are released to help fight off infection. However, asthma appears when too many of these particles are produced at the wrong time. The body releases particles when exposed to an irritant in the environment. Irritants vary based on the person, and may be allergens, cold air or even exercise. The wheezing and shortness of breath begin when irritation in the pathways of the lungs obstructs or blocks the flow of air.

Those with a history of repeated wheezing, cough or chest tightness may have asthma. A chronic cough or wheeze with weather changes, exercise, viral illnesses or exposures to chemicals, dust, or tobacco smoke may also indicate the condition. House dust mites are one common trigger that can be controlled by covering pillows, mattresses and box springs with cases. Washing all bedding in hot water every two weeks also cuts down house mite populations. Air filtering devices, reduced humidity levels and removing bedroom carpeting where mites like to live also helps control them.

Allergies to animals are another possible allergic trigger. Cat saliva, cat and dog dander can all be irritants. Some people may need to remove pets from the house. Another option is to use an appropriate air filter and confine the animal to a carpet-free area away from bedrooms.

Other allergens are plant pollens, including various trees, grasses and weeds. Those with allergies or asthma may do better staying inside when pollen counts are high. If possible, use home and car air conditioners rather than opening windows during bad pollen seasons such as late spring and early fall. Outdoor or indoor mold can also cause a serious allergy for asthma sufferers. Make sure there is good ventilation to prevent mold from growing. Some other irritants that may be in the air include tobacco smoke and smoke from wood-burning stoves and fireplaces. Perfumes may also set off attacks in some people.

Allergy testing can confirm allergies. A small amount of the allergenic product is placed in the skin to see if a reaction occurs. Asthma can also be diagnosed with a pulmonary function test, and by checking if symptoms are relieved by a bronchodilator medication. This medication reverses airway spasm.

One way to manage asthma is to take a peak expiratory flow value (PEF) reading, done by blowing in a tube that measures the flow of air when blowing out. PEF readings help doctors and patients know how well-controlled asthma is by checking how much air the person can blow. Treatment for asthma is based on the severity of the symptoms. In mild cases, avoiding triggers and occasionally using inhalers to open airways are all that is needed. As symptoms become more severe, a step-by-step approach to medications is used. Steps include trying other inhalers to treat swelling, as well as pills to fight inflammation and allergies. Rarely, oral steroids are needed.

Eczema

Eczema is another chronic condition related to asthma. It is essentially the same allergic reaction but involves the skin, resulting in an itchy rash. The rash is usually red and swollen with areas that may drain in severe cases. The rash tends to cycle, getting better and then worse. Scratching makes it worse.

In adolescents, the rash is generally on the hands, eyelids, neck, feet, and areas that flex such as the bend of the knees and elbows. Ninety per cent of people with eczema get it before the age of five, but usually improve with age. Triggers include too much hand washing, wearing wool clothing or other materials that do not allow the skin to ‘breathe,’ sweating and stress. Treatment involves avoiding allergic triggers as well as medicines. Medical therapies can include steroid creams of various strengths. Recently, a non-steriod cream has been introduced that can be very effective. Occasionally oral antihistamines and rarely oral steroids are used for severe itch or rash.

Allergic Rhinitis

Allergic rhinitis can also be a difficult chronic condition. Up to nine per cent of people with allergic rhinitis also have asthma. It runs in families, and more than two-thirds of people are diagnosed by the time they are 20. The main feature of this condition is a continuing dry cough and runny nose. Other symptoms include sneezing, itching in the eyes, ears and throat and nasal congestion. A chronic condition is indicated if these symptoms have lasted longer than three months.

Allergy testing to determine triggers may help with diagnosis and treatment. Triggers are similar to asthma and include perfumes, tobacco smoke, dust, air conditioning, strong odors, potpourri, burning candles, cold air and animal dander.

Avoiding the allergen causing discomfort is the first step in treatment. Next, try to eliminate it. If this is a long or difficult process, an intranasal corticosteroid (a nose spray prescribed by a doctor) may help. It works by helping to stop the inflammation process causing the runny nose. The sprays are well tolerated and have few side effects. Dryness or irritation of the lining of the nose may be one result. Those who develop nosebleeds should stop using the spray. It can take a few days to a few weeks of treatment to get the most benefit out of the medication. Antihistamine medications have also been proven to reduce these symptoms. Rarely, oral steroids are required.

Occasionally, regular allergy shots can make someone ‘immune’ to their old allergens. Fortunately, allergic rhinitis resolves in some children as they age. As the world grows more industrialized, the number of people with this problem is predicted to increase.

Recognizing these chronic illnesses at an early stage can help in their treatment. If any of these conditions sound familiar, talk with your family doctor.