[Paleopsych] NYT: 'Diabesity,' a Crisis in an Expanding Country

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Health > Personal Health: 'Diabesity,' a Crisis in an Expanding Country
http://www.nytimes.com/2005/03/29/health/29brod.html
March 29, 2005

    By [1]JANE E. BRODY

    I can't understand why we still don't have a national initiative to
    control what is fast emerging as the most serious and costly health
    problem in America: excess weight. Are our schools, our parents, our
    national leaders blind to what is happening - a health crisis that
    looms even larger than our former and current smoking habits?

    Just look at the numbers, so graphically described in an eye-opening
    new book, "Diabesity: The Obesity-Diabetes Epidemic That Threatens
    America - and What We Must Do to Stop It" (Bantam), by Dr. Francine R.
    Kaufman, a pediatric endocrinologist, the director of the diabetes
    clinic at Children's Hospital Los Angeles and a past president of the
    American Diabetes Association.

    In just over a decade, she noted, the prevalence of diabetes nearly
    doubled in the American adult population: to 8.7 percent in 2002, from
    4.9 percent in 1990. Furthermore, an estimated one-third of Americans
    with Type 2 diabetes don't even know they have it because the disease
    is hard to spot until it causes a medical crisis.

    An estimated 18.2 million Americans now have diabetes, 90 percent of
    them the environmentally influenced type that used to be called
    adult-onset diabetes. But adults are no longer the only victims - a
    trend that prompted an official change in name in 1997 to Type 2
    diabetes.

    More and more children are developing this health-robbing disease or
    its precursor, prediabetes. Counting children and adults together,
    some 41 million Americans have a higher-than-normal blood sugar level
    that typically precedes the development of full-blown diabetes.

    'Then Everything Changed'

    And what is the reason for this runaway epidemic? Being overweight or
    obese, especially with the accumulation of large amounts of body fat
    around the abdomen. In Dr. Kaufman's first 15 years as a pediatric
    endocrinologist, 1978 to 1993, she wrote, "I never saw a young patient
    with Type 2 diabetes. But then everything changed."

    Teenagers now come into her clinic weighing 200, 300, even nearly 400
    pounds with blood sugar levels that are off the charts. But, she adds,
    we cannot simply blame this problem on gluttony and laziness and
    "assume that the sole solution is individual change."

    The major causes, Dr. Kaufman says, are "an economic structure that
    makes it cheaper to eat fries than fruit" and a food industry and mass
    media that lure children to eat the wrong foods and too much of them.
    "We have defined progress in terms of the quantity rather than the
    quality of our food," she wrote.

    Her views are supported by a 15-year study published in January in The
    Lancet. A team headed by Dr. Mark A. Pereira of the University of
    Minnesota analyzed the eating habits of 3,031 young adults and found
    that weight gain and the development of prediabetes were directly
    related to unhealthful fast food.

    Taking other factors into consideration, consuming fast food two or
    more times a week resulted, on average, in an extra weight gain of 10
    pounds and doubled the risk of prediabetes over the 15-year period.

    Other important factors in the diabesity epidemic, Dr. Kaufman
    explained, are the failure of schools to set good examples by
    providing only healthful fare, a loss of required physical activity in
    schools and the inability of many children these days to walk or bike
    safely to school or to play outside later.

    Genes play a role as well. Some people are more prone to developing
    Type 2 diabetes than others. The risk is 1.6 times as great for blacks
    as for whites of similar age. It is 1.5 times as great for
    Hispanic-Americans, and 2 times as great for Mexican-Americans and
    Native Americans.

    Unless we change our eating and exercise habits and pay greater
    attention to this disease, more than one-third of whites, two-fifths
    of blacks and half of Hispanic people in this country will develop
    diabetes.

    It is also obvious from the disastrous patient histories recounted in
    Dr. Kaufman's book that the nation's medical structure is a factor as
    well. Many people do not have readily accessible medical care, and
    still many others have no coverage for preventive medicine. As a
    result, millions fall between the cracks until they are felled by
    heart attacks or strokes.

    A Devastating Disease

    There is a tendency in some older people to think of diabetes as "just
    a little sugar," a common family problem. They fail to take it
    seriously and make the connection between it and the costly, crippling
    and often fatal diseases that can ensue.

    Diabetes, with its consequences of heart attack, stroke, kidney
    failure, amputations and blindness, among others, already ranks No. 1
    in direct health care costs, consuming $1 of every $7 spent on health
    care.

    Nor is this epidemic confined to American borders. Internationally,
    "we are witnessing an epidemic that is the scourge of the 21st
    century," Dr. Kaufman wrote.

    Unlike some other killer diseases, Type 2 diabetes issues an easily
    detected wake-up call: the accumulation of excess weight, especially
    around the abdomen. When the average fasting level of blood sugar
    (glucose) rises above 100 milligrams per deciliter, diabetes is
    looming.

    Abdominal fat is highly active. The chemical output of its cells
    increases blood levels of hormones like estrogen, providing the link
    between obesity and breast cancer, and decreases androgens, which can
    cause a decline in libido. As the cells in abdominal fat expand, they
    also release chemicals that increase fat accumulation, ensuring their
    own existence.

    The result is an increasing cellular resistance to the effects of the
    hormone insulin, which enables cells to burn blood sugar for energy.
    As blood sugar rises with increasing insulin resistance, the pancreas
    puts out more and more insulin (promoting further fat storage) until
    this gland is exhausted. Then when your fasting blood sugar level
    reaches 126 milligrams, you have diabetes.

    Two recent clinical trials showed that Type 2 diabetes could be
    prevented by changes in diet and exercise. The Diabetes Prevention
    Program Research Group involving 3,234 overweight adults showed that
    "intensive lifestyle intervention" was more effective than a drug that
    increases insulin sensitivity in preventing diabetes over three years.

    The intervention, lasting 24 weeks, trains people to choose
    low-calorie, low-fat diets; increase activity; and change their
    habits. Likewise, the randomized, controlled Finnish Diabetes
    Prevention Study of 522 obese patients showed that introducing a
    moderate exercise program of at least 150 minutes a week and weight
    loss of at least 5 percent reduced the incidence of diabetes by 58
    percent.

    Many changes are needed to combat this epidemic, starting with schools
    and parents. Perhaps the quickest changes can be made in the
    workplace, where people can be encouraged to use stairs instead of
    elevators; vending machines can be removed or dispense only healthful
    snacks; and cafeterias can offer attractive healthful fare. Lunchrooms
    equipped with refrigerators and microwaves will allow workers to bring
    healthful meals to work.

    Dr. Kaufman tells of a challenge to get fit and lose weight by Caesars
    Entertainment in which 4,600 workers who completed the program lost a
    total of 45,000 pounds in 90 days. Others could follow this example.

    Next week: Helping an overweight child.