10 years ago the International Diabetes Federation Diabetes Atlas indicated that just over 150 million people had diabetes worldwide.  Now, less than 10 years later the survey shows 285 million worldwide cases, more than half of those aged between 20 and 60.

To put this rise in perspective in 1985 it was estimated there were 30 million worldwide cases.  India and China lead the way in cases but are followed closely by the US.  About 9% of the US population is found to have been diagnosed with diabetes (26.8 million) at a rate of $198 billion a year.  This is 52.7% of worldwide spending on diabetes, an incredible number!

At this growth rate the number should reach above 435 million by 2030 (US population today is 303 million).  As I’ve said before, if we really want to cut down on health expenditures this is a major area of public health we have to target and not just by paying it lip service.  Since a majority of cases are type II (insulin resistance with obesity and diet as contributors) we need to target the food and food services industries and the way the consumer is informed of their decision.

Of course a huge problem is getting people to realize the long term health affects of diet and exercise which is very difficult.  Incremental weight loss and an abstract number like fasting glucose levels are difficult means to motivate people into life altering habits. This has been proven with the massive diet industry which peddles unnecessary measures to lose weight.  This is easily seen by the yo-yo effect from people losing weight off of a diet and then gaining the weight back, only to have to find another diet.  I’ve seen family members go from diet program to diet program to find one which will “keep the weight off” but the only way to keep the weight off is to change your eating and exercise habits,  dirty secret the industry wishes to keep from you.

I guess I got way off topic but the obesity and diabetes problems are closely related, so there’s my diatribe for the day…


One of the blogs I have rabidly followed over the last year and a half is White Coat Underground.  The author, PalMD, is a physician (internist) and a well-respected member of the science/medicine blogosphere and last night a post of his caught my eye.

Obesity is a bad thing. This isn’t a moral judgment. If one of your values is long life and good health, then obesity is a bad thing.

PalMD talks a little bit about his struggles with his weight and how he is starting a “diet” which he will be updating regularly.  This is interesting for a physician to speak about publicly, especially someone who is so well followed on the internet.  Although he blogs under a pseudonym his real identity was outed a while ago so his patients can find him if he wants.

I think this is a good point for the public, especially in light of the negative comments I’ve seen about Dr. Benjamin’s (Obama’s pick for Surgeon General) weight.  Physicians are as normal as anyone else.  While walking through downtown Chicago you see the whole spectrum of human existence and vices; obesity, smoking, unhealthy eating, and even a few harsh words exchanged.  You never know which of these people is a nurse, physician, public health official or medical student.  One would like to think that physicians lead a healthier lifestyle than everyone else but the truth is they are just as vulnerable to unhealthy habits as everyone else.  It is true that a lot of these vices are stopped or scared out of medical students because of the knowledge, images and patients they see but just knowing the risk doesn’t stop people from participating in unhealthy behavior.

My question is one that has been asked before but I’d like to get some input from the readers; should physicians and health care workers in general be held to a higher standard of healthy living, and if so, why?  You can respond in the comments or by email which can be found on the right sidebar.

Does it surprise anybody?  Not I…

Severe Childhood Obesity is a new classification which is described as being a weight that is greater than the 99th percentile for gender and age.  The researchers out of Wake Forest University Baptist Medical Center are the first to use this classification of obesity in children.  The measure isn’t perfect, children have a high variance in height and growth spurts come at different ages having far different effects on height and weight.  But it is a stable measure across time and very indicative of how our children are measuring up to their peers.

From the years 1976-1980 the rate of severe obesity was 0.8%, climbing to 3.8% in the years 1999-2004.  Another worrying data point from the study is that a third of children that were severely obese have metabolic syndrome.  Metabolic syndrome is a measure of high blood pressure, cholesterol and insulin levels which grouped together are risk factors for heart attack, stroke and diabetes.

The researchers said, “these findings demonstrate the significant health risks facing this morbidly obese group…this places demands on health care and community services, especially because the highest rates are among children who are frequently underserved by the health care system.”

At a time when the nation is caught up in a health care debate it is evident that in order to decrease our costs in the future we have to target our children and teach them healthy eating.  This has to be a concerted effort at home and in schools (we send our kids to school to learn and here’s what they learn) to eat healthier, exercise and generally care more about what we put in our bodies.

ResearchBlogging.orgSkelton, J., Cook, S., Auinger, P., Klein, J., & Barlow, S. (2009). Prevalence and Trends of Severe Obesity Among US Children and Adolescents Academic Pediatrics DOI: 10.1016/j.acap.2009.04.005

According to Margaret Wente they do, in her Globe and Mail editorial from last week she unwisely states “get fat, live longer.”  The problem Margaret has here is using one study to come to a conclusion when there is a mountain of evidence out there and most of it points toward moderate weights being far more healthy and associated with a lower mortality.  From the editorial:

Here’s more bad news for all those folks who are nagging us about our weight. The evidence is very clear that, unless you are morbidly obese with health problems, losing lots of weight is bad for you, not good.

I have to disagree Margaret, weight loss is usually marked by healthy activities, which is more important than baseline weight or even significant weight loss; those with an active and healthy lifestyle continually show lower mortality than those with sedentary lifestyles.

Travis at Obesity Panacea (maybe the best health blog name on the net) has a smart takedown of the article which does well at explaining how this study fits into the body of obesity research.  The results of the study become more clear when put in the correct context and all confounding factors are taken into consideration.  Travis wraps the whole situation up nicely in his post.

So what’s the take-home message from thislengthy post (aside from ignoring health advice from Margaret Wente)?  Body weight affects your health, but not as much as diet and exercise.  So focus on those healthy behaviors, and you’ll be moving towards a longer, healthier life.

Obesity has proven to be a physiological condition that raises the risk of developing diabetes (as well as cardiovascular disease and other diseases).   Diabetes is currently a condition which can be maintained chronically through weight loss, diet restrictions and medicinally-mediated glycemic control.  The fact that treatments have become so efficient at maintaining patient health is great for all diabetic sufferers.  The flip side of the coin is that being terminally medicated is very expensive.  Between testing, frequent physician visits and never-ending medication the amount spent on this disease is overwhelming.  It is estimated that in the US in  2007 alone the medical costs for those with prediabetes was $25 billion. A glimpse into childhood obesity and diabetes can give us an idea of what we are facing in the health care world in the future.

The prevalence of obesity continues to rise for all age groups and ethnicities in the US.  The graph on the right is from the CDC monitoring program and shows the number of people with diabetes tripling from 1980 to 2006! The rate for 0-44 year olds moved from 0.6 in 1980 to 1.6 in 2006.  Combined with the fact that youths with type 2 diabetes have almost quadruple the rates of obesity as non-diabetic US youths this presents a troubling picture for public health.

One major piece of the diabetic puzzle is what we feed our kids in school.  As Ann Cooper says in a wonderful TED talk, “All of us send our kids, or grandchildren, or nieces, or nephews, to school and tell them to learn, you know, learn what’s in those schools. And when you feed these kids bad food, that’s what they’re learning.”  And the data is there to back Ann up, when schools offer fried foods and desserts, place vending machines nearby, or have low-nutrient energy-dense foods served a la carte there is a significantly higher likelihood of obesity in the school.

And the problem runs deep as many schools are given less than $1 a day to feed a child, a budget that any administrator would find hard to succeed with.  This leads to a situation where corporations can profit from making contract deals with schools, providing food and vending services to bolster the school’s budget.  I would say it is true that corporate America is much more interested in what we’re feeding our children than we as a public are.  They have shown the commitment to change our children’s eating habits and that they are willing to shoulder some of the cost to do it.

This meal of nachos and chocolate milk is on the menu everyday at many Chicago area high schools and has been brought into some middle schools as well.  And according to this Chicago Tribune report the longest line of kids snakes around to a group of lunch workers shoveling the yellow corn chips onto plates everyday, this is the most popular entree in Chicago schools!  At 471 calories and 25.3 grams of fat is it surprising that Chicago-area schools have almost double the national childhood obesity rates?

A study in England found that 2 of the 3 schools assessed did not meet the government standards.  Furthermore, the study found that children from more deprived socio-economic backgrounds chose less healthy food (maybe due to it’s lowered cost? Corporate subsidy in the lunchroom).  They recommend a pricing scheme which monetarily rewards healthy eating behaviors.

Studies have shown that schools are improving and moving closer towards USDA recommended meals (don’t get me started on how big a crock the USDA is though).  From 2004-2007 the availability of regular-sugar/fat items decreased in both middle and high schools.

But the blame doesn’t all lie on the schools.  The majority of calories taken in by children will be in their home or outside of school.  To add to this, many high school have open campus policies where the students can leave to get lunch.  It is important that we educate this generation of students in healthy eating and the benefit of making food at home because my generation is probably lost.  We came about in the McDonald’s led fast food boom.  I remember there being one fast food option when I was young and by the time I reached high school age I could choose from 10 different drive-thrus, all in a small West Texas town of 8,000.  Guess where I ate the majority of my high school lunches?  And then guess where I ate a majority of my meals once I got to college?  That’s right, Whataburger and Chik-Fil-A both had setup up deals where my school meal credits were directly transferrable to their menus, how wonderful and unhealthy at the same time, just what most college kids are looking for.

By 2020 what will the prevalence of obesity be in our population?  What will the age distribution rate look like and how will childhood obesity rates evolve?  These are some serious questions to ask and with the public up in arms over “preventing” disease rather than treating disease (which is a myth and public fallacy in itself, when was the last time you went to the physician and he told you that eating worse and not exercising would be good for you?) this is a great time to look at our priorities in schools.  Alone in this institution are we able to reach a whole generation of our population and teach them the importance of eating well.  I think it’s time that some serious weight be thrown behind these ideas.

Ann Cooper says that $8 billion would be a great starting point for revamping our school menus.  That is the current budget of the National School Lunch Program, split between 30 million kids that comes out to $2.49 a meal.  Considering overhead and and payroll that brings the total down to less than $1/day.  In Los Angeles the school spends $0.56 per meal.  That means it costs less to feed a kid in a Los Angeles school for a week than buying a latte at Starbucks.  That is a pretty sick number, and a testament to how far neglected we’ve let these massive public institutions get.  We’re willing to spend billions to save jobs and companies that have proven they will not act in our best interest but we’re unwilling to spend fractions of that to properly feed and educate our children about one of the most important aspects of health, what you put in your body.  This is a shame and an indictment of America’s priorities, one that I hope we take notice of and change the way things are going.

Guh, D., Zhang, W., Bansback, N., Amarsi, Z., Birmingham, C., & Anis, A. (2009). The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis BMC Public Health, 9 (1) DOI: 10.1186/1471-2458-9-88

Zhang, Y., Dall, T., Chen, Y., Baldwin, A., Yang, W., Mann, S., Moore, V., Le Nestour, E., & Quick, W. (2009). Medical Cost Associated with Prediabetes Population Health Management, 12 (3), 157-163 DOI: 10.1089/pop.2009.12302

Liu, L., Lawrence, J., Davis, C., Liese, A., Pettitt, D., Pihoker, C., Dabelea, D., Hamman, R., Waitzfelder, B., Kahn, H., & , . (2009). Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth Study Pediatric Diabetes DOI: 10.1111/j.1399-5448.2009.00519.x

FOX, M., DODD, A., WILSON, A., & GLEASON, P. (2009). Association between School Food Environment and Practices and Body Mass Index of US Public School Children Journal of the American Dietetic Association, 109 (2) DOI: 10.1016/j.jada.2008.10.065

GOULD, R., RUSSELL, J., & BARKER, M. (2006). School lunch menus and 11 to 12 year old children’s food choice in three secondary schools in England—are the nutritional standards being met? Appetite, 46 (1), 86-92 DOI: 10.1016/j.appet.2005.08.005

Terry-McElrath, Y., O’Malley, P., Delva, J., & Johnston, L. (2009). The School Food Environment and Student Body Mass Index and Food Consumption: 2004 to 2007 National Data Journal of Adolescent Health DOI: 10.1016/j.jadohealth.2009.04.007

BRIEFEL, R., WILSON, A., & GLEASON, P. (2009). Consumption of Low-Nutrient, Energy-Dense Foods and Beverages at School, Home, and Other Locations among School Lunch Participants and Nonparticipants Journal of the American Dietetic Association, 109 (2) DOI: 10.1016/j.jada.2008.10.064


Welcome to my “Diabetes Series”!  Just like my “Cancer Basics” series I’ll be updating this every so often in order to hopefully make the research a little more palatable for the general public.  I hope you like it and you continue to tune in!

Scientists from the Salk Institute have unlocked another piece of the diabetes puzzle with their discovery of a mechanism that links endoplasmic reticulum (ER) stress and gluconeogenesis.  This is an interesting finding because it identifies a pathway that bridges the gap between obesity and diabetes.  Obesity has been shown to be a major factor in the development of diabetes but the picture on why this is so has been fuzzy.  Now the picture has become more clear with the discovery of a duel molecular sensor involved in both the ER stress response and gluconeogenesis.

There are two factors (more…)