Established nicotine-vaping link ignored while obesity fails to account for prediabetes surge that in kids “independently is a toxic metabolic state causing an increased risk of cardiovascular disease and mortality”

by Clark Miller

Published October 1, 2022

Bad news. Really bad. There is no hope for the increasing numbers – a doubling over past years – of American kids developing prediabetes, a condition, according to trusted medical experts cited in this recent article, which “independently is a toxic metabolic state causing an increased risk of cardiovascular disease and mortality”. No hope because America’s medical experts don’t have a pill to give them, and without a pill to prescribe, their “hand are tied”. Sadly, there is nothing we can do for them, but wait for needed new $billions in funding to provide a medication to regulate blood sugar levels for them.

Prediabetic blood sugar levels that are, in adults and kids, most effectively and naturally regulated and more importantly, prevented, by managing  risk factors that are behavioral and achievable: modest reductions in body weight; changes in diet; increases in regular physical activity; and cessation of use of nicotine, a direct causative agent in insulin resistance and linked to childhood prediabetes by surges in use of nicotine by vaping and combustible cigarettes

Behavioral changes supported by a healthy family with invested parents and others making changes to eliminate ACE and other stressors contributing to compulsive stress eating, along with changes to reduce sedentary behaviors. Changes supported for families by behavioral health and other professionals to provide, most importantly, the gains in sense of self-efficacy, empowerment, and confidence for self-generated changes that are themselves therapeutic, empowering, healing. Unlike passive provision of a pill, lacking the ongoing affirmation of  experiencing direct benefits of self-generated changes that promote health and well-being, and feel good.

Where have we seen this before?

That’s right, yes. Exactly. American Medicine’s proven cures for potentially lethal problem substance use and increasingly lethal epidemics. It’s a pill, or injection. Pills promised 15 years ago and longer that will cure addiction, just around the corner, just needing a few more $billions in public healthcare funding. Without those “miraculous” cures, their hands would be tied in treatment of the brain disease of substance use. America’s doctors helpless if not for their access to addictive substances dispensed in “medication assisted treatment” (MAT) programs. Not requiring other treatments at all. Not behavioral changes or engagement in therapy for support making personal changes. Therapies that are the only treatments to address and resolve the deep, underlying sources of inner need and distress actually driving the compulsive substance use. Nah, just the “medication” that’s been increasingly available for decades. Over the decades while deaths have mounted. Decades of calls for more $billions in public healthcare funds.

BTW, how is that going?

How the actual, lethal fuck is that going?

But where were we?


We need to pay attention to what the useful idiots experts are telling us. They know what’s best, that goes without saying.

Prediabetes is an abnormal state of glucose homeostasis in which blood glucose levels are elevated above the range of normal but are not high enough to be classified as diabetes. A staggering 28% of U.S. youth ages 12 to 19 years are living with prediabetes. This number more than doubled from 1999 to 2018. Prediabetes and obesity are strongly correlated in a high-risk genetic backdrop, making them almost two sides of the same coin. The ongoing COVID-19 pandemic has caused a rapid increase in both these problems in children.

So, prediabetes in kids is all about obesity. A lethal lie, here’s why. 

From a post published April 4 – 

As predicted, large increases among youth in use of nicotine by inhalation as use of e-cigarettes (vaping) has surged are associated with newly reported doubling of teen prediabetes prevalence over the same period. That was foreseeable based on the direct link between nicotine and risk of diabetes onset, as explained here at A Critical Discourse beginning in August of 2018 and in posts repeatedly after that. The new report follows publication of the same predictable results for adults four weeks ago, described here.

Prediabetes prevalence nearly doubled among U.S. youth from 1999 to 2018, national data indicated.

According to National Health and Nutrition Examination Survey (NHANES) data on over 6,500 youth, the prevalence of prediabetes increased from 11.6% in 1999-2002 to 28.2% in 2015-2018, Junxiu Liu, PhD, of Icahn School of Medicine at Mount Sinai in New York City, and colleagues reported in JAMA Pediatrics.

. . .  Some of the sharpest spikes in prevalence occurred in youth with obesity. Increases across BMI groups form 1999-2002 to 2015-2018 were:

Underweight or normal weight: 9.42% to 24.3%

Overweight: 15.3% to 27.5%

Obesity: 18.2% to 40.4%

This dramatic spike in prediabetes prevalence was apparent for youth of all ages. Specifically, those ages 12 to 15 saw a rise in prediabetes prevalence from 13.1% in 1999-2002 up to 30.8% by 2015-2018. As for older teens ages 16 to 19, these rates likewise more than doubled from 10% up to 25.6%.

That’s a distortion of the results. For kids with obesity, the prevalence about doubled, that is, increased by a factor of 2.2. For overweight kids, prevalence was close to doubling, a factor of 1.8. 

An exact doubling would be an increase by a factor of 2.0. 


And for kids underweight or normal weight, the increase in prevalence was greater than for overweight or obese kids, 2.6, or a factor of slightly more than two and a half. 

That is, the spike in prevalence of prediabetes for youth over a period of surging use of nicotine by vaping was not accounted for by obesity. The increase was about as much for overweight as for obese (a higher BMI than overweight) and was, notably, highest for kids who were normal weight or underweight. 

youth vaping

One more time, just to be clear. Over a period of rapid expansion of use of nicotine by young people, nicotine with a direct causal relationship to insulin resistance, prediabetes surged in young people, not just obese young people. The gain in prevalence (9.4. percent to 24.3 percent) for underweight or normal weight – a factor of 2.6 – was greater than for overweight kids (1.8, about a doubling) and obese kids, about the same as overweight – 2.2. 

And as summarized here, the report published in JAMA Pediatrics found that the increases stayed true across socioeconomic and other variables such as weight, household food security, race, and age”. 

Back to the MEDPAGE Today piece – 

There is increasing evidence to support that even before its progression to type 2 diabetes, prediabetes independently is a toxic metabolic state causing an increased risk of cardiovascular disease and mortality. It is important to note that pediatric type 2 diabetes is a significantly different disease from adult type 2 diabetes in that it has a very aggressive course that leads to rapid beta cell failure and insulin dependence.

No reason to doubt that, and more reason to reject the type of medical approach that takes agency, self-efficacy, and empowering health behaviors out of health in order to protect power and authority, dependence on pharmaceutical cures doled out by prescribers. With predictable results

From a post updated April 8, 2021 – 

Self-efficacy: The Opposite of Helplessness and Powerlessness

Another, complimentary factor strongly supported by extensive research as protective against relapse and required generally for change is self-efficacy, or sense of confidence in one’s own choices, abilities, and effectiveness to make the changes needed to resolve a problem or regain health and safety.

Self-efficacy is developed, reinforced, experienced and strengthened in a process of interaction with skilled therapists over which experiences that include active changes (not passive changes like taking a pill) are experienced as effecting positive changes in the patient’s life and resolution of problems.

That is, a key factor established by research as required to stop and protect against return to problem substance use requires work in therapy over time in order for patients to internalize, own, and self-affirm personal agency and effectiveness, control, in behavioral and other changes that protect against problem substance use.

Medical visits and the sham “treatments” are a barrier to self-efficacy, that is a barrier to healing and wellness. That process is subverted when vulnerable patients are reinforced, by medical visits for a non-medical problem – in the false belief of a passive fix for substance use, a pill.

The trained belief in a non-existent condition “addiction” as a medical condition with medical treatments was predicted, all along, to generate illness, “treatment” failures, ultimately lethal epidemics.

But back to the medsplaining of why America’s kids trapped in a worsening prediabetes epidemic must wait for medical experts and institutions to a) be provided  new $billions in public resarch funds to produce a pill b) to be dispensed by doctors and passively used by children without need for family changes in diet, physical activity, other health behaviors – 

Unfortunately, there are currently no FDA-approved pharmacological treatment options that can be offered to children with prediabetes. Their visit to the “prediabetes expert” is often a frustrating one because all we can offer are lifestyle changes such as increased activity and decreased caloric intake. This can sound a lot like “eat healthy and exercise,” and seems unhelpful and generic to most patients. While intense lifestyle changes, when practiced stringently and persistently, can improve outcomes in some patients, they require continued effort, resources for healthy foods, and structured activity that are not universally available. This is especially true for structurally disadvantaged groups — often the groups with a higher prevalence of prediabetes.

This lethal advice demands deconstruction. 

because all we can offer are lifestyle changes such as increased activity and decreased caloric intake

That’s right, but misses what is so problematic about that for medical experts: the acknowledgment that regarding those changes, involving and requiring competent provision of multiple supports and therapies – including family; motivational; behavioral; mental health to address mood and other intrapsychic barriers to change; most importantly psychodynamic, cognitive and other therapies to address the complex inner states driving the stress-induced, compulsive use of food and other substances driving metabolic syndromes including insulin resistance – as medically trained experts you are entirely out of scope of practice

That admission would be nearly intolerable, a real blow to perceived status. That threat requires more rationalization, more distracting distortions. 

This can sound a lot like “eat healthy and exercise,” and seems unhelpful and generic to most patients

Really? Because results of surveys establish that patients experience offers provided by trained behavioral health professionals, provided with rationale, motivational therapies,  and collaborative treatment planning, as seeming to them “generic” and ‘unhelpful”? You just neglected to cite that research? 

While intense lifestyle changes, when practiced stringently and persistently, can improve outcomes in some patients

That’s a lie by omission. 

The benefits of indicated changes are general, affecting basic metabolic processes, biochemistry, and physiology.  The metabolic syndromes and measures – including insulin resistance – that predict prediabetes, risk of diabetes and associated harms are established (see also here and here) as responsive in young people to simple dietary and exercise changes.  

Similar benefits were achieved by adults on a low-fat, vegan diet. 

And the changes are found to be lasting, including in this study with an “ethnically diverse pediatric population”. 

That’s predictable, if the therapies and supports, as described above, are provided by competent professionals in the field of behavioral health, because the interventions and changes target inner states and processes like insight, confidence and motivation for change and for maintenance of change, also family, mental health, and other barriers to change.

And it’s a distortion –

The needed changes are simple lifestyle changes in diet, activity, other behaviors that once adopted and experienced as beneficial become “lifestyle” with little or no additional effort required. Changes – diet, regular activity, and stopping use of nicotine – that address a wide spectrum of physical health risks, other stressors. 

they require continued effort, resources for healthy foods, and structured activity that are not universally available

What type of  burdensome, intolerable “continued effort” is required once kids and their families shift away from using nicotine and unhealthy foods making them feel sick and experience the improved mood, joy, and family functioning that comes with increased physical activity? 

Is a market a “resource for healthy foods”? Like the one where the high-fat, processed, high-sugar foods fueling prediabetes and other conditions are being picked up instead of the fruits, vegetables, and whole grains there? 

Daily walks, trips to the park, involvement in school and community sports are much too “structured” to access? 

And if some specific options for lifestyle changes are not “universally available”, then the indicated treatments become less important, less life-saving? 

Messaging and instillation of American Medicine’s lie that a pill is sufficient and effective substitute for those inner and behavioral changes has predictably generated increasingly lethal substance use and depression epidemics. It robs vulnerable Americans, including kids in a surging diabetes epidemic, of the motivation to access and use therapies to make the necessary, effective, evidence-based, durable behavioral and other changes that will protect them. Effective, protective change instead of being deceived and betrayed by the promise of a pill: Now I’m on the modern cure that’ll take care of this. I’m okay now, cured. That’s what the medication is for

SSRI anyone?

Advocating against or discouraging patient  and family engagement and investment in the inner and behavioral changes is unconscionable. The correct response from a medical provider is, “The needed supports and therapies for evidence-based treatments involving lifestyle changes are out of my scope of practice. I’ll be glad to help your family access those.” 

The lack of safe, FDA approved medications leaves clinicians helpless in offering a broader range of solutions to young patients with prediabetes. Consequently, there is a glaring unmet need to allocate funding for research in this population.

That lack of medication is unfortunate only for a medical model that generates lethal epidemics by controlling public healthcare funds to assure that they remain exclusive source of the proven cure, regardless of associated lethality of epidemic outcomes. 

Not unfortunate, barely relevant for a vulnerable population, a sickened culture desperately in need of return to sane and evidence-based approaches that focus on prevention, personal empowerment, individual, family and community health, safety, and wellness. 

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.”

– Pierre Bourdieu  Outline of a Theory of Practice (1972)

In Bourdieu’s Theory of Practice, heterodoxy is dissent, challenge to what “goes without saying” – the accepted, constructed doxa, “knowledge”, reality, that goes without saying precisely because it “comes without saying”, without real scrutiny, untested, unquestioned. The function of doxa is not knowledge or truth or promotion of the collective good, but to protect and serve the interests of those with the power, the cultural capital, to create it.

Why A Critical Discourse?

Because an uncontrolled epidemic of desperate and deadly use of pain-numbing opioid drugs is just the most visible of America’s lethal crises of drug misuse, suicide, depression, of obesity and sickness, of social illness. Because the matrix of health experts and institutions constructed and identified by mass media as trusted authorities – publicly funded and entrusted to protect public health – instead collude to fabricate false assurances like those that created an opioid crisis, while promising medical cures that never come and can never come, while epidemics worsen. Because the “journalists” responsible for protecting public well-being have failed to fight for truth, traded that duty away for their careers, their abdication and cowardice rewarded daily in corporate news offices, attempts to expose that failure and their fabrications punished.

Open, critical examination, exposure, and deconstruction of their lethal matrix of fabrications is a matter of survival, is cure for mass illness and crisis, demands of us a critical discourse.

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.

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