Children With Diabetes: Diet and Lifestyle Tips for Weight Management
By April Hopcroft
Childhood obesity is an escalating concern worldwide. Experts share insights on how to effectively blend healthy habits into the everyday routines of kids dealing with diabetes and obesity.
Many people with diabetes struggle with excess body weight, and children are no exception. While type 2 diabetes is uncommon in children and youth, research suggests that approximately 75% of children with type 2 diabetes have obesity, and most of the rest are overweight. Estimates of childhood obesity in youth with type 1 diabetes range from 13% to 33%.
Maintaining a healthy weight not only improves diabetes management but also reduces the risk of developing complications down the road, such as cardiovascular and kidney disease. Children with obesity are more likely to enter young adulthood with excess body weight, so it’s important to be proactive in implementing healthy eating habits.
Guidelines recommend that children and teens with a high body mass index (BMI) be referred for intensive behavioral interventions. The most effective interventions include education and counseling from different types of healthcare providers, such as obesity medicine specialists, dietitians, social workers, and mental health providers to discover and address underlying causes of weight gain.
Both healthy eating habits and physical activity are important for diabetes management and overall physical health. However, it’s important to recognize that weight loss is “generally 90-95% what you eat,” according to Dr. Sophia Yen, clinical associate professor at the Stanford Pediatric Weight Clinic and co-founder of Pandia Health.
Yen noted that there have been some exceptions to this among children who participate in sports for three hours Monday through Friday and five hours on the weekends.
Weight management for children with diabetes and obesity can feel daunting, so what’s the best way to incorporate healthy habits into your daily routine?
What is the ideal diet for children with diabetes?
One of the most important considerations is eating a diet that supports health and provides sufficient amounts of vitamins and minerals that growing bodies need to function, said Dr. Tamara Hannon, director of the Pediatric Diabetes Program at Riley Hospital for Children in Indiana.
More specifically, this means eating a diet that contains micronutrients from plant foods like vegetables, grains, and fruits. Hannon said a healthy diet should also include low-fat dairy for calcium, vitamin D, and other nutrients, as well as lean sources of protein, such as lean meats, beans, soy, nuts, and legumes. Getting enough fiber – from plant foods, nuts, and legumes – helps slow the absorption of glucose, reduces LDL cholesterol, and aids in digestion.
Very-low carbohydrate or ketogenic diets are not recommended for children and adolescents, according to the latest guidance from the American Academy of Pediatrics (AAP). Overall, the AAP guidelines emphasize that it’s important not to restrict nutrient intake while children and teens are growing.
“We often see celebrities and weight loss programs endorsing carbohydrate restriction through low carb or ketogenic diets, but the evidence is limited on the physical, metabolic, and psychological effects of these dietary plans for children and teens,” Hannon said.
Instead, Hannon highlighted the importance of reducing nutrient-poor carbohydrates – such as processed snack foods and sugary drinks.
Tips for cultivating healthy eating habits for children with diabetes and obesity
Overall, Yen emphasized that the focus should be on risk reduction, rather than elimination. For example, consider someone who eats cake every day of the week and suddenly stops eating cake for a week. They may experience more cravings and be more likely to overeat and experience weight gain, compared to someone who gradually reduces the amount of desserts they eat.
1. Start with the MyPlate model
Yen advocated for following the MyPlate model, which recommends the following approach for children and adolescents with diabetes: 
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Vegetables and fruit should take up at least half of the plate. Ideally, vegetables should be non-starchy – think broccoli, carrots, cucumber, mushrooms, peppers, and tomatoes.
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Lean protein should make up at least one-quarter of the plate. Many animal sources of protein contain saturated fats, which can increase the risk of cardiovascular disease. Opt for lean proteins, which have less saturated fat. These include skinless turkey or chicken breast, eggs, salmon, tuna, and low-fat dairy products like milk and yogurt. Plant-based sources of protein include nuts, beans, and tofu.
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Carbohydrates should take up no more than one-quarter of your plate. This includes bread, pasta, grain products, starchy vegetables (like squash and potatoes), beans, fruit, and dairy products.
2. Avoid liquid calories and sugary drinks
The MyPlate model recommends drinking water or another zero-calorie beverage. Sugary beverages such as soda, energy and sports drinks, coffee or tea-based drinks, and fruit juice, all contain high amounts of added sugar and increase caloric intake.
It’s also important to reduce a child’s intake of food or beverages with added sugar.
“Milk is the only exception to the zero-calorie rule,” Yen said, as it provides a good source of calcium for growing bodies. While nonfat milk is the best option for weight loss, she said drinking 1% or 2% milk is also okay.
For kids and teens who must have a fizzy drink, Yen suggested the following trick to gradually switch from regular to diet soda. The first week, mix 3 parts regular soda to 1 part diet soda. The second week, combine half regular and half diet soda. The third week, progress to 1 part regular soda mixed with 3 parts diet soda. By week four, this will have “trained your taste buds” to drink 100% diet soda, Yen said.
3. Add vegetables
Noodles, pasta, and rice are popular foods for kids and teens. Hannon suggested seeing where you can add vegetables and lean proteins for added fiber and volume.
Eating less starchy foods and more vegetables and lean proteins will help curb hunger cravings and provide much-needed nutrients and fiber. You could also consider swapping high-carb pasta for lower-carb veggie options, such as zucchini noodles (“zoodles”) or spaghetti squash.
4. Eat regular meals
Fasting for too long can increase food and caloric intake when you break the fast, Hannon said.
She recommended reducing between-meal snacks, particularly high-sugar foods, and processed foods like chips, crackers, desserts, and granola bars. Consider replacing these items with any of the following healthy snacks:
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Vegetables, grains, and fruit
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Low-fat dairy
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Proteins like lean meats, beans, soy, nuts, and legumes
For children and teens with busy schedules, it’s a good idea to carry around emergency food to eat on the go, such as 150-calorie granola bars or 100-calorie packages of nuts. Find more snack ideas from dietitian Alexandra Frost, who lives with diabetes.
5. Limit screen time
Yen emphasized the importance of limiting screen time to a maximum of two hours per day for non-school activities, such as Netflix, social media, YouTube, and other entertainment.
For children under five years of age, it’s best to strive for minimal screen time. Children under two years of age should ideally have no screen time, Yen said.
With less screen time, ideally, children and teens will spend more time being physically active. Reducing screen time is also important for ensuring better sleep. Many research studies have found that poor quality sleep has been linked to weight gain and increased risk of obesity.
6. Aim for at least 30 minutes of physical activity per day
While weight loss is mostly determined by what you eat, regular exercise has been shown to help maintain weight loss over time. Exercise also improves insulin sensitivity, reduces diabetes complications, and improves mental health.
To lose weight, children and teens should strive to be physically active for at least 30 minutes each day. This aerobic exercise should leave them sweaty or out of breath, which indicates that they’re pushing themselves, Yen said.
It can be challenging to incorporate regular physical activity into a busy schedule. Breaking up exercise into shorter bouts is a good way to start. Indeed, research has shown that so-called “exercise snacking” leads to improvements in fitness and overall health.
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Take a 5-10 minute study break every hour to get up and move. This could include learning a TikTok dance, taking a walk around the block, or doing squats or jumping jacks.
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Swap out a chair for a yoga ball – the bouncy seat exercises your core and burns calories.
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Try an active videogame, such as Ring Fit Adventure for Nintendo Switch or Beat Saber games.
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Even better, involve all family members in a round of basketball, tag, hide and go-seek, or other active games.
It’s important to monitor glucose during and after exercise, ideally using a continuous glucose monitor (CGM), in order to prevent hypoglycemia.
The bottom line
Overall, Yen emphasized the importance of finding realistic ways to incorporate healthy habits into your daily routine. “Diet means what you eat every day,” she said. “It shouldn’t mean being deprived.”
To reap the benefits of healthy eating and prevent weight gain, dietary changes should become life-long habits, not just something you try for a short period. The same goes for being physically active.
Establishing healthy eating and exercise habits at an early age will help children transition to self-management in young adulthood and set them up for a lifetime of success.
“Whatever healthy living changes we make, should be for forever,” Yen said.
Learn more about diabetes and weight management for children:
