This month US Medicine focuses on the widespread medical problem that is diabetes. Affecting over 17 million Americans, or 6.2% of the population, almost 6 million of this population does not even know they have the disease, according to The Obesity Society at www.obesity.org. Diabetes is typically classified as either Type 1 or Type 2. Type 1 diabetes is an autoimmune disease with clear genetic links that usually is first manifested in the young. However, over 90% of the cases are classified as Type 2 diabetes. Type 2 diabetes also has an associated genetic predisposition but is more closely linked to obesity and a sedentary lifestyle in adults. Craig Hanis, PhD, a professor at the Human Genetics Center at the University of Texas Health Science Center in Houston states, “People sometimes have the misconception that if we say something is genetic, then they can’t do anything about preventing diabetes and its complications.”¹

Research suggests this is not the case since lifestyle changes in diet and exercise can delay or prevent Type 2 diabetes in 60% of high risk patients, according to Hanis. Certainly lifestyle modification is not the end of the story, as obesity is no guarantee of Type 2 diabetes and lean people do develop the disease. That said, The Obesity Society claims that almost 90% of the people who develop Type 2 diabetes are overweight. Efforts to understand the genetic and environmental changes that lead to the insulin resistance that defines Type 2 diabetes may eventually lead to treatments that can minimize or eliminate the disease. In the meantime, this is one area where the patient can have tremendous influence on the course and progression of the disease and their general health.

Obesity, usually defined as a body mass index (body weight - kg/height m2) greater than 30, has increased dramatically in the last two decades with only Colorado and the District of Columbia having obesity rates less than 20% of their populations. The Centers for Disease Control and Prevention have compiled data for obesity and diabetes rates for every county in the United States. Graphical depiction of this data shows a striking correlation between obesity prevalence and the incidence of diabetes (www.cdc.gov/obesity/data/trends.html). Perhaps even more alarming is the concurrent trend of obesity in children and adolescents that is now occurring at double digit rates as a percentage of the pediatric population. Clearly this is a development with national healthcare consequences (we have not even mentioned the link between obesity and heart disease) that the United States can ill afford in this era of tightening healthcare budgets. Many public health experts have described the burgeoning American waistline as an obesity epidemic with profound public health consequences. This is not just an American problem, as most developed countries are also grappling with the health impact of obesity.

Before the 1980s, obesity rates were relatively low and stable as a percentage of the general population around the world. Multiple factors have been implicated as contributing to the surge in obesity rates of the past two decades in developed countries. Greater quantity and availability of high caloric foods, increased stress levels at work and at home, passive leisure activities, and decreased physical activity at work are just some of the explanations being postulated to explain this epidemic. The host of chronic, lifetime limiting diseases like diabetes that are associated with obesity is extensive. Some experts have even suggested that the obesity epidemic may lead to conditions where our children do not enjoy the same traditional increase in lifespan over their parents – a sobering thought.

I personally wage a daily battle with my own weight. I find myself desiring the morning donut with my coffee while calculating the time at the gym it will take to burn it off. Unlike smoking, which clearly is a personal choice when someone first starts, abstention from food is not an option. Like many, food is a reward for a job well done or used to celebrate special occasions. Finding balance with food in our modern society is indeed a challenge.

As with any public health epidemic of this magnitude, federal healthcare providers must lead by example in their own lives and in their interactions with patients. I make it a point to discourage smoking in my patient population. Admittedly, healthy diet and exercise recommendations rarely find purchase in my patient care plans, something I plan to change. Recently, I purchased an elliptical exercise machine for my home to limit the “I was too tired to go to the gym” excuse for not exercising. Granted, a small personal commitment on my part but one I think healthcare providers must make if they presume to have similar expectations of their patients. Ben Franklin’s words ring as true today as they did when he uttered them, “An ounce of prevention is worth a pound of cure.” In this case, the pun is intended.

1. Gebel, Erika PhD. “Why Me? Understanding the Causes of Diabetes.” American Diabetes Association–Diabetes Forecast. Oct 2010. http://forecast.diabetes.org/magazine/features/why-me-understanding-causes-diabetes. Accessed October 10, 2010.

The opinions expressed here are solely those of the author and not necessarily those of U.S. Medicine, Marathon Medical Communications, Inc. or the United States government and its agencies.U.S. Medicine welcomes comments from its readers. Address correspondence to editor@usmedicine.com.

back to November articles