Weighing in on Diabetes: Taking Small Steps to Prevent Type 2 Diabetes Can Reap Huge Rewards in the Long Run

By Perry, Patrick | The Saturday Evening Post, September-October 2003 | Go to article overview

Weighing in on Diabetes: Taking Small Steps to Prevent Type 2 Diabetes Can Reap Huge Rewards in the Long Run


Perry, Patrick, The Saturday Evening Post


As the number of overweight Americans continues to soar, health experts, economists, and researchers are scrambling to discover ways to tackle the health crisis facing our nation. In addition to elevating the incidence of heart disease, stroke, and kidney disease (see "Kidney Alert" on page 56), obesity dramatically increases one's risk for adult onset diabetes. With two out of three Americans waging a battle of the bulge, we are also witnessing an epidemic of type 2 diabetes.

Unfortunately, the epidemic of adult onset diabetes includes an unprecedented number of young children, a disease rarely seen in previous generations. The problem is so serious that in June, the CDC issued a warning that unless serious measures are taken to reverse the trend of obesity in American youth, one in three children born in 2000 will become diabetic. The twin evils of oversized meals and undersized activity weigh in as principal culprits in this health crisis, but parents can intervene.

"When it comes to children, there are two successful strategies to prevent obesity," said Dr. William Dietz, an obesity expert at the CDC, who echoes the sentiments of experts around the world. "First, parents should take control of the TV set and limit how much TV their children watch. Parents also need to be in charge of what children are offered to eat."

The problem is not isolated to the United States, since other countries also struggle with the growing problem. Some countries, such as Australia, are proposing a "fat tax" to combat the problem as part of a shock tactic to wake Australians up to the diabetes epidemic, directly linked to food choices and inactivity.

To learn more about the problem and measures that one can take to help prevent or reduce one's risk for developing adult onset diabetes, the Post spoke with Alan Moses, M.D., associate professor of medicine at Harvard Medical School and chief medical officer of the Joslin Diabetes Center.

Post: We are hearing many terms that refer to preconditions to diabetes type 2. What is "prediabetes"?

Moses: Health and Human Services Secretary Tommy G. Thompson introduced the term "prediabetes" to increase awareness that impaired glucose tolerance--a condition that is not yet diabetes--is a progenitor of diabetes. More important, when physicians recognize prediabetes in their patients, they can actually intervene to help "prevent" or delay overt diabetes. While a very significant public-health message, the diagnosis is especially significant to the patient, because when prediabetes is discovered, he or she can actively do something to reverse and prevent adult onset diabetes.

Post: Is prediabetes synonymous with other terms such as metabolic syndrome, Syndrome X, or insulin-resistance syndrome?

Moses: Syndrome X, metabolic syndrome, or insulin-resistance syndrome are, in fact, the same condition, even though you can have metabolic syndrome without prediabetes. In essence, all these terms refer to the constellation of abnormalities first described in 1988 by Dr. Gerald Reaven at Stanford University. All present a significant risk for the development of diabetes.

Post: How is prediabetes identified?

Moses: Blood tests for prediabetes are not routinely performed. But if you have a positive family history of type 2 diabetes, are significantly overweight or obese, and/or come from a high-risk ethnic group--African-American, Latino, or Asian-American--the risk of developing diabetes is quite high, especially if you have all the risk factors. The goal is to identify people at higher risk early in the process, so you can intervene and effectively reduce or halt the progression to diabetes.

Post: How many people are estimated to have prediabetes?

Moses: The number is estimated to be roughly equivalent to the number of people with diagnosed diabetes, which is about 17 million Americans. But certainly, even more people have metabolic syndrome.

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