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Even if the level of obesity remains constant, the epidemic of diabetes will continue.
By Conni Bergmann Koury, Editor-In-Chief
Many other factors contribute to the increasing number of people with diabetes, including most notably the increasing prevalence of obesity. In fact, even if the level of obesity remains constant, the epidemic of diabetes will continue, according to research published in Diabetes Care. Experts said that it is likely that current figures underestimate the future problem of diabetes prevalence.
INTERNATIONAL DIABETES FEDERATION
In developing countries, people with diabetes are most often in the 45-to-64-year age range, while the majority of those with the disease in developed countries are older than 64. Estimates of the International Diabetes Federation (IDF) predict that, by 2030, the number of people with diabetes who are older than 64 will be 82 million in developing countries and 48 million in developed countries.
The IDF, in conjunction with the International Obesity Task Force of the International Association for the Study of Obesity, released a report entitled, “Diabetes and Obesity: Time to Act.” The report calls for action on the part of individuals, health care professionals, industry and policy makers.
An IDF news release issued at the American Diabetes Association 64th Annual Scientific Sessions meeting said: “Strategies must encourage and facilitate physical activity and a healthy diet, and control access to [calorie] dense food and drinks. Health promotion, particularly in relation to diet, weight control and physical activity, can play a part but it is not sufficient on its own. In particular for our children, policies and legislation need to ensure safe play outdoors, safe transport to and from school by foot and bicycle and protection from highly influential advertising which promotes inappropriate (and unnecessary) consumption of [calorie] dense food and drink.”
TWIN EPIDEMIC: OBESTY AND DIABETES
Obesity and diabetes can be though of as twin epidemics. At the 2004 annual meeting of the American Association of Clinical Endocrinologists, Allen M. Spiegel, MD, said that by 2030 there will be almost 30 million people with diabetes in the United States alone. Dr. Spiegel, who is director of the National Institute of Diabetes & Digestive & Kidney Diseases, said “the burden is enormous, yet much is preventable.” The epidemic of diabetes is paralleled by the “absolute crisis” of obesity, he said.2
A recent study in the Journal of the America Medical Association updated the prevalence of overweight in children and obesity in adults.3 Using body mass index as an indicator, the study found that in 1999 to 2002, among adults aged 20 years of age and older, 65.1% were overweight or obese, 30.4% were obese, and 4.9% were extremely obese. For the same time frame, among children aged 6 through 19 years, 31% were either at risk for overweight or were overweight with 16% classified as overweight.
The data is part of the National Health and Nutrition Examinations Survey, which looked at 4,115 adults and 4,018 children in 1999 to 2000 and 4,390 adults and 4,258 children in 2001 to 2002. The authors noted that there continues to be disparities by sex and between racial/ethnic groups in the prevalence of overweight and obesity.
ADA MEETING
Studies presented at the ADA annual meeting underlined the risk of diabetes and obesity to children and especially minorities. British researchers reported that most parents of obese children were unaware that their children’s weight was abnormal.4 “When parents do no recognize overweight and obesity in their children — as up to three-quarters of the parents in our survey did not — we are missing critical partners in our effort to halt a developing epidemic of childhood type 2 diabetes,” said Alison N. Jeffery, MSc, senior research nurse at Derriford Hospital, Peninsula Medical School, Plymouth, UK. The British Early Bird Survey included 300 children and their families.
The other survey found that more than half of a group of 1,700 eighth graders had one of the following risk factors for diabetes and premature heart disease: overweight, high cholesterol, high blood pressure or blood glucose abnormalities.5
The children were from Texas, North Carolina and California, and 75% were Hispanic or African-American. The study is part of the Studies to Treat or Prevent Pediatric Type 2 Diabetes Study Group (STOPP-T2D).
LIFESTYLE INTERVENTIONS NEEDED
In another report published in Diabetes Care,6 researchers found that obese patients with type 2 diabetes can better manage their weight with a lifestyle intervention program. In the Improving Control with Activity and Nutrition study (ICAN) 147 patients were randomized to lifestyle case management with a registered dietician or usual care. This low-cost intervention, $350 per person, resulted in greater weight loss, reduced weight circumference, reduced HbA1c level, less use of medications and improved health-related quality of life.
Three leading health groups have joined forces to fight the leading causes of death in this country. For the first time ever, the American Cancer Society, the ADA and the American Heart Association have come together to provide a set of recommendations.
According to a news release from the ADA, “Everyday Choices for a Healthier Life,” is a 3-year advocacy, public and professional education campaign based on four preventive strategies. The recommendations are:
• Consume a healthy diet as a key component to achieving an maintain a healthy body weight.
• Be physically active.
• Don’t smoke and avoid tobacco smoke.
• See a physician to assess your personal health risks.
“Health care costs are climbing steadily, but the national investment in prevention was recently estimated at less than 5% of the total annual health care expenditures,” said Eugene Barrett, MD, PhD, president of the ADA and professor of medicine and pediatrics at the University of Virginia’s Diabetes Center. “We plan to pool our expertise and resources to encourage greater collaborative efforts among federal and state governments, private health care providers, insurers and policymakers to increase the funding and opportunities for prevention.”
Visit the following Web sites for more information: IDF’s Time to Act at www.idf.org; the National Institute of Diabetes & Digestive & Kidney disease at www.niddk.nih.gov; and the joint effort of the American Cancer Society, the ADA and the American Heart Association at www.everydaychoices.org.
1. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes. Estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047-1053.
2. Spiegel AM. The National Institutes of Health research agenda for the prevention of diabetes and obesity. Presented at the American Association of Clinical Endocrinologists 13th Annual Meeting. April 28 to May 2, 2004. Boston.
3. Hedley AA, Ogden CL, Johnson CL, et al. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA. 2004;291:2847-2850.
4. Jeffery AN, Voss LD, Metcalf BS, et al. Overweight families: unaware and unconcerned. Presented at the American Diabetes Association 64the Scientific Sessions. June 4 to 8, 2004. Orlando, Fla.
5. Pilot feasibility study group of the Studies to Treat or Prevent Type 2 Diabetes (STOPP-T2D) Collaborative Group. Presented at the American Diabetes Association 64the Scientific Sessions. June 4 to 8, 2004. Orlando, Fla.
6. Wolf AM, Conaway MR, Crowther JQ, et al. Translating lifestyle intervention to practice in obese patients with type 2 diabetes. Diabetes Care. 2004; 27:1570-1576.