NEW LARGE STUDIES: KIDS’ HEALTH IN SERIOUS DECLINE IN AMERICA TIED TO STRESS AND SUBSTANCE USE
Conditions worsening most over recent years include anxiety, sleep problems, stress-driven overeating and obesity, and prediabetes, pointing to social and institutional failures underlying pervasive, generalized child illness
by Clark Miller
Published August 15, 2025
The alarming yet unsurprising study outcomes, published last month in the Journal of the American Medical Association (JAMA) point to cultural, social, and institutional failures as threats to the mental and physical health of U.S. children compared to in comparable countries and measured variously, ranging from sudden and prematurity-related infant mortality to motor vehicle deaths,; to sleep, depression, anxiety, hopelessness and other mental health problems; to eating disorders and obesity; and pain and GI tract disturbances.
Lead author Christopher Forrest, MD, PhD, of Children’s Hospital of Philadelphia addressed the remarkable breadth of symptoms, chronic medically-treated conditions, and illnesses that have worsened as pointing to and demanding identification of underlying driving factors, “underlying systemic factors that are influencing the health of children more broadly [tied to] the developmental ecosystems where children live and grow”.
“the developmental ecosystems where children live and grow”
As summarized starkly in that piece –
Findings Temporal trends from 2007 to 2023 have significantly worsened for child mortality; chronic physical, developmental, and mental health conditions; obesity; sleep health; early puberty; limitations in activity; and physical and emotional symptoms.
Meaning US children’s health has deteriorated across a broad spectrum of indicators, highlighting the need to identify the root causes of this fundamental decline in the nation’s health.
New figures released within days by the CDC add to those concerns for a likely under-detected and growing condition for adolescents – an apparent rise in prevalence of prediabetes to 33 percent, and in any case a revision of a 2015-2016 estimate upward from about 20 percent to about 28 percent.
While the accuracy of the alarming figures related to how they were calculated is under contention, the trend is not disputed, as described in a MEDPAGETODAY piece –
Samar Hafida, MBCCh, an endocrinologist at Boston Medical Center and representative for the American Diabetes Association, said the new analysis “wasn’t very transparent,” but she noted that the CDC’s updated estimate generally squares with what doctors are seeing — an increase in youth with obesity and elevated blood sugar levels that put them at risk for serious future health problems.
“It could be that maybe the number [is] slightly inflated, but I would hesitate to dismiss it,” she said. ..
Still, confirmed rates of obesity and diabetes among kids are rising.
The diabetes association recommends that children and adolescents should be screened for type 2 diabetes starting at age 10 if they are overweight or have obesity or another risk factor for the disease. Focusing on healthy diet, exercise, and other lifestyle factors is key, noted Hafida.
“It’s still a call to action,” she said. “There will likely be a surge in early onset type 2 diabetes that we are not prepared to deal with.”
While prediabetes is broadly understood as representing blood sugar levels posing risk of development of type 2 diabetes, gravity of the pre-condition itself is under-appreciated, especially for kids. That’s explained in detail, with links to relevant research and evidence, in this post from October of 2022. Here’s an excerpt or two –
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.
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.
Preceding and linked to in that post, a series of related posts established that obesity alone cannot account for the surge in youth prediabetes and diabetes over recent years, instead evidence pointing strongly to the role of a known factor increasing insulin resistance – nicotine – delivered over years of a youth vaping epidemic at concentrations far exceeding those delivered in traditional cigarettes. That’s all covered in those posts.
Some things are beginning to tie together, and that’s important if we are to begin to face a latent youth health crisis.
Overeating and obesity in youth, with rare exception, are the result of unconscious, compulsive, soothing behaviors providing the very strong reward of distraction from or moderation of the discomfort of inner states like confusion, worry, emotional pain, fear, others … “stress”. That’s explained here (scroll down).
Compulsive food use is no different psychologically, behaviorally, clinically or diagnostically from other mood-altering substances, including the applicability of DSM diagnostic criteria.
The primary difference is that, unlike as with food, with extremely rare exceptions, America’s parents generally do not for other mood-altering substances (e.g, alcohol, THC, opioids) provide children unrestricted access to, model harmful misuse of, and/or encourage use as a way to soothe and distract their children to cope with the parents’ own overwhelming stress. Just with food.
The same – psychological, emotional – forces drive initiation of compulsive nicotine use in youth, contributing to not just risk of prediabtes, but multiple, magnifying stressors and conditions as well including sleep problems and pain perception.
It all ties together and comes in the context of America’s top experts distorting the outcomes and validity of national surveys that are methodologically fatally flawed, disguising or hiding signs of worsening youth substance use epidemics.
The unifying factor is stress: parent stress, child stress, family stress, increasingly worsened by multiple factors over past years including a disruptive pandemic and public health response that left children disoriented, behind, unconnected, without safe refuge, and/or missing from care after school closures; generalized heightened insecurity and role overload for parents and children attempting to cope with financial, material, social, world, and environmental threats and instability; adult substance use epidemics impacting families by deaths and impairments.
Lacking social or family support, functional mental health and public health systems, and humane social safety nets, stress generates attempts to cope by transient soothing relief from compulsive use of substances and behaviors whose costs exacerbate illness and stress.
In an extended interview well worth reading from public radio WBUR, lead author Christopher Forrest explores those ties, layers, connections, sociological, psychological, and social factors, also arriving at stress at the base.
Early in the interview, Forrest and host Meghna Chakrabarti have an exchange that goes to the core of the meaning of the remarkable result that nearly all of the 170 health indicators studied point to worsening child wellness.
CHAKRABARTI: Well, you know, in a sense it may — the study and the data may confirm what a lot of Americans have anecdotally experienced or observed. But I wonder if — and we will dive deeper into the actual health indicators in a moment, Dr. Forrest. But it’s so dire, right? I mean like every, almost every single of 170 health indicators, American kids being less healthy and sometimes far less healthy than they were back in 2007.
As a researcher, was there a moment where you were like, “Hang on?” Whenever data comes out so skewed and all numbers are down across the board, like did you wonder, “Wait, was there something wrong? Was there something amiss in the analysis?”
FORREST: Great team doing this work. We checked things in triplicate, so we were pretty confident of the numbers.
And the other thing, Meghna, is that we wanted to conduct a study that would address prior criticisms of work that has been reporting declines in children’s health. So for example, the CDC reports individual statistics. By individual, I mean individual diseases — obesity rates, anxiety rates, and so on. And sometimes those studies get criticized because they’re limited data sources or just one indicator.
So we wanted to use multiple data sources — parents’ assessments, kids’ assessments of their own health, physicians’ assessments, vital statistics like mortality to see what would happen. And when they all triangulated on the same conclusion, we began to scratch our head and say, you know, there’s a bigger story here. It’s just more than just the data that we’re seeing. There’s something happening in the developmental ecosystem of kids. And in some ways we all take responsibility for this because it’s been happening in our backyards.
CHAKRABARTI: Yeah. In our backyards and in our own homes, right?
FORREST: Yeah.
Some of the connections and effects are indirect, generational, potentially self-perpetuating, revelatory, and sobering. Infant mortality in the U.S. has become 80 percent greater than in comparable European and Asian countries and is fueled primarily by more premature births, in turn driven by poor maternal health.
FORREST: So there has been a very slight decline over the last 20 years, but babies definitely are more likely to be born early in this country compared to those countries, and that’s the big driver of the differences.
CHAKRABARTI: They’re more likely to be born early in this country. Okay.
FORREST: Yes.
CHAKRABARTI: And what are some of the — I mean, I’m sure there’s probably like 10,000 causes to that, but what are some of the most important ones?
FORREST: Yeah. I like to think of infant health as really a women’s health issue. We know that healthy women, when they get pregnant, become healthy pregnant women. Healthy pregnant women deliver healthy babies. They’re much less likely to deliver babies born prematurely. So you really have to, you know, not talk about so much just prenatal care, but what about women’s health as they enter pregnancy?
We do know that about one in three women are entering pregnancy obese, and they’re at increased risk for diabetes while pregnant and hypertension. Those are not — if not controlled well, those are not good things for the baby’s health. So the combination of spotty access to prenatal care for many women as well as beginning their pregnancies unhealthy themselves, is really, I believe, the major driver.
Now you can go back and say, well, why are women unhealthy? And that’s sort of a different kind of set of questions, but that’s really what’s driving the premature rates.
“in the developmental ecosystem of kids … in our own homes”
That’s no mystery. Obesity in adults as in kids is the result of unhealthy diet combined with compulsive, inner-distress-driven use of excess calories for soothing, reflecting stress and other forms of poor mental health, often reflecting early adverse childhood experiences (ACE) that set them up developmentally, psychologically, and physiologically for challenges in regulating emotional responses and for an array of emotional, behavioral, and physical conditions of illness.
That is, the effects on health and mortality of American children represent forces acting full circle and generationally “in the developmental ecosystem of kids” and their parents “in our own homes” to generate emotional injury, compulsive substance use, and associated transgenerational harms.
CHAKRABARTI: Wow. Okay. So then, I mean, you talked about some mental health — deterioration in mental health. That also includes — these are things I think people have heard of and probably even experienced in terms of the lives of children that they know — more anxiety, greater amounts of loneliness, higher reports of depression. You even talked about like fatigue and pain, experience of pain going up in kids.
FORREST: I know. That’s really, as I mentioned earlier, I think that was one of the big surprises to me, that things like fatigue, pain, abdominal symptoms, menstrual symptoms for teenage girls, headaches, this sort of physical symptomatology has been increasing.
But Meghna, we know that kids are experiencing an increasing amount of stress. And that stress manifests itself in some kids as anxiety and in some kids as pain. You know, it gets very challenging to kind of pinpoint any one cause, because one cause can produce multiple conditions.
America’s kids are stressed to the point of generalized, chronic illness and a mental health crisis, in their homes, their increasingly unsafe communities, in their world of live-streamed genocide, in their schools.
Unable to gain the stabilizing emotional connection they need from their stressed, overwhelmed natural support systems, they increasingly, compulsively use – as is modeled for them by the adults in their lives – substances like food, nicotine, THC, and misprescribed amphetamine, for episodic relief that comes at the cost of unprecedented incidence of obesity and looming, latent epidemics of diabetes, nicotine dependence, and associated illness.
While media and top experts celebrate their wellbeing as a remarkable public health achievement. And get away with it.
Because we don’t care enough.
