[Paleopsych] NYT: 'Diabesity,' a Crisis in an Expanding Country
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Health > Personal Health: 'Diabesity,' a Crisis in an Expanding Country
March 29, 2005
By 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
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
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
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
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
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
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
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.
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