Yale researchers have found that the causative factors associated with childhood obesity are different for poorer and wealthier nations and the treatment is complex.

The researchers published their findings in Nature Metabolism.

Lead study author Dr. Sonia Caprio from Yale School of Medicine said, “In poorer countries, we’re seeing not only a rise in childhood obesity but in parallel with malnutrition.”

“In the U.S., the problem is inertness, but there is more awareness about the dangers of consumption of sugar and soda,” she added. “In China, India, and South America, they are pushing these products and soda consumption is very high. And the water is not drinkable.”

Childhood obesity is often associated with serious complications such as type 2 diabetes, fatty liver disease, high cholesterol, and cardiovascular disease.

Dr. Caprio’s study focuses on understanding how obesity causes type 2 diabetes, a metabolic condition characterized by high blood sugar caused by insulin resistance.

The researchers explained that the type 2 diabetes risk associated with childhood obesity is not a function of body mass index but of how and where the body stores fat.

Dr. Caprio performed MRIS scans on obese children and found that those who were prone to obesity complications have an extra layer of subcutaneous fat that is much thinner than average.

The body pushes the fat into other tissues, especially the liver when it is unable to store the fat in the abdomen anymore. Dr. Caprio explained, “The liver then becomes inflamed and contributes to the development of insulin resistance.”

The study found that those who have thinner subcutaneous fat “re marching to cardiovascular complications six to seven years down the road, including hypertension and kidney disease.”

Type 2 diabetes increased by nearly 5 percent among people under 20 years of age from 2002 to 2012, according to the CDC and NIH. And the metabolic disease has been found more aggressive in children than adults, said Dr. Caprio.

“With kids, it is very difficult to reach a glucose level that is satisfactory and controlled,” she added. “And the drugs that adults use to manage glucose are not yet approved for kids.”

Dr. Caprio noted that childhood obesity leads to type 2 diabetes during the teenage years, making it difficult to control a child’s diet. She said better nutrition is the only way to curb obesity.

“There has been a change in the perception of obesity as being more than just a cosmetic problem,” Caprio continued. “Compared to 10 or 15 years ago, we’re in a much better situation of knowledge of the problem.”