As if the predictions of diabetes to come were not already grim enough, a new report released by the Centers for Disease Control and Prevention now predicted that one in three American adults may have diabetes by 2050, with the number of diabetes patients projected to double or triple over the next 40 years. While the report blames the predicted increase primarily on an aging population, more members of high-risk minority groups, and longer survival in people who already have diabetes, my perspective on the cause of this epidemic is somewhat different.
Let me address these three points in order. Many chronic diseases get blamed on aging when in fact the real culprit is lifestyle choices. With diabetes in particular, the amount of metabolically active muscle mass you retain as you age has a huge impact on insulin action, given that skeletal muscles are the primary storage site for carbohydrates. If you exercise regularly and recruit all of your muscle fibers with intense or vigorous activities, you will lose less muscle mass and retain a much higher level of insulin sensitivity. If you also eat fewer refined carbohydrates that are quickly converted into blood glucose and that are lacking in fiber and essential anti-diabetic nutrients (like magnesium and vitamin D), your insulin action will remain higher as you age.
As for an increase in high-risk minority groups being the cause, let’s re-examine the case of two biologically related minority groups with completely different rates of diabetes. The Pima Native Americans of Arizona have an extremely high incidence of obesity, insulin resistance, and type 2 diabetes, with more than half of all Pima adults 35 years and older with type 2 diabetes. However, another group of Pimas from whom the Arizona group descended was discovered in Mexico, and despite sharing the same gene pool, these two groups differ dramatically in their levels of body fat. Here again, lifestyles make a difference: the Mexican Pimas are physically active farmers who eat a traditional diet of natural foods such as wheat, squash, beans, cactus buds, squawfish, and jackrabbit, while the Arizona Pimas eat highly refined, nutrient-poor foods and have a sedentary lifestyle. It should come as no surprise that the Arizona Pimas are the only ones who have type 2 diabetes.
Finally, just the fact that some people are surviving longer with diabetes (and adding to the growing number of cases) is not in itself cause for concern. Individuals with good self-care practices and adequate diabetes control are likely not developing diabetes-related health problems at the same rate as those with less healthy lifestyles and inadequate glycemic control.
What can we do to stop the rising number of cases? For starters, we have to address the causes on the personal and community levels, along with as a nation. Some small steps are being taken in that direction with the CDC’s launch of the Diabetes Prevention Program through the Y and others. Really, the bigger problem to address is that despite our knowledge of what we should be doing, most Americans are not following through on this. What we have is not a lack of motivation; rather, it is a behavior problem that is both personal and society-wide.
For example, for their safety, we strap our toddlers into strollers or keep them sitting in front of the television instead of walking whenever they can or playing outside. We keep our kids sitting and motionless during most of the school day, and then we feed them an excess of unhealthy calories for lunches and snacks. We adults stand and wait for elevators when we could take the stairs, and we stand on escalators instead of walking up and down them (even at the American Diabetes Association meetings, where everyone is supposed to know better).
What is it going to take to turn around our lifestyles for the better on a wide scale? In my opinion, we need to involve money. If all of us could have more change in our pockets if we choose a healthy lifestyle, the habits of Americans will likely finally start to change for the better. Let’s start by trying to get more health insurers interested in lowering health insurance rates for individuals with healthy behaviors, and let’s get more businesses interested in doing the same for their employees. Hopefully, we will not have to take as drastic a stand as they have in Japan, where companies are being fined based on the number of employees they have with waistlines above 32 inches. But, at this point, we have to start taking more steps in that direction instead of just wringing our hands and worrying about what’s to come (without our intervention).
Small changes can make a big difference in the health and waistlines of Americans. Just standing more each day burns calories and tips the scales in the direction of weight loss instead of further weight gain. Eating a salad with your dinner substantially lowers calorie intake at that meal, and simply taking in 50 calories fewer than you need a day can result in a five-pound loss of fat weight in a year, without any effort.
Take a stand yourself today by becoming a role model of a healthier lifestyle for everyone that you come in contact with. Use social networks to get others involved. Put your money where your mouth is. Let’s all get moving more, eating better, and staying thinner and healthier—starting today!