T2D: The Longest Mile: Type 2 Diabetes-The Leading Cause of Blindness, Kidney Failure, and Lower Limb Amputation, as Well as One of the Major Risk Factors for Heart Attack and Stroke-Now Strikes Every Third Person Born in This Country

Article excerpt

A WEEK PASSES by without a story concerning the epidemic of obesity and Type 2 diabetes. T2D is the most common form of diabetes, frequently associated with excess weight and insulin resistance (inadequate action of insulin). This epidemic is real and frightening. It is estimated that the riskof developing Type 2 diabetes for individuals born in the year 2000 (our children and grandchildren) is 32.8% for men and 38.5% for women. The fact that every third person in this country will go on to develop T2D in his or her lifetime is staggering.

The magnitude of the impact of T2D on individual health and societal health care resources is enormous. The annual direct and indirect cost of diabetes care is about $150,000,1300,000. In addition to being the leading cause of blindness, kidney failure, and lower limb amputation, it has emerged as one of the major risk factors for heart attack and stroke, robbing people, on average, of 12 to 15 years of life.

At the same time, a number of clinical trials has demonstrated convincingly that T2D can be prevented. Surprisingly for many, the most powerful prevention is achieved with lifestyle changes. Up to 60% of people who otherwise would have developed diabetes were able to prevent it by modifying their lifestyle. The old adage about "an ounce of prevention" goes far beyond its true wisdom when applied to T2D. Because 90% of people who are going to develop it are overweight and somewhat sedentary, the two main components in the lifestyle change are weight loss and activity. Sounds simple, but it is extremely difficult to do. The sheer number of books offering "a quick and simple" weight loss recipe is a sure sign that the problem is much more complex than these books imply. Otherwise, the situation would have been resolved a long time ago.

A survey conducted by Consumer Reports of the efficacy of various diets reveals that only three percent of the people in the survey had managed to complete formal weight-loss programs. Among those who had finished, the average success rate was 26%. Overall, 95% of those who lose weight on any diet regain it within the next 12 to 24 months. Not surprisingly, most people give up, as frustration and denial replace drive and perseverance.

How do we, practically speaking, lose weight, become more active, and prevent T2D? Of course, some things are beyond our control. For instance, Type 2 diabetes has a very strong genetic component. If one parent has it, the chances of a child developing this disease during his or her lifetime are 30%. Still, we need to understand how to change our unhealthy lifestyles. The first thing to understand is the law of conservation of energy: For weight to be stable, the energy consumed must equal the energy spent. It follows that, if we consume (eat) more energy than we spend, we gain weight. If we spend more than we consume, we lose weight. There is no miracle and no revelation in this law.

Let us consider the following example: If Mr. X wishes to lose 10 pounds, how shall his proposed energy balance be calculated? One important assumption is important at this point: one pound of weight equals 3,500 calories stored in fat. Therefore, for him to shed 10 pounds, Mr. X must consume 35,000 calories less than he spends. Provided he wishes to accomplish his goal in six months (182 days), he would have to have his daily energy balance at 192 calories. In other words, he must lose, on average, 192 calories every day for six months. Is it doable? Absolutely. Can he do it by diet alone? Yes, but it would be more difficult. A better way is to consume 100 calories less and increase his spending by an extra 92 calories, for a total negative balance of 192 calories.

It is no secret that most of us do not like to exercise. In fact, the desire to exercise seems to be inversely proportional to our age. Healthy preschoolers, almost without exception, are remarkably active. Chasing around after a three- or four-year-old can be exhausting. …