ATHLETIC CONSULTING TRAINING REPORT - www.cbathletics.com
"Grim Statistics PART II of the Western Lifestyle
"Obesity and Diabetes: A deadly connection"
- GRIM STATISTICS: THE OBESITY & DIABETES PARALLEL EPIDEMICS...
in part to many reasons, the whole world, on average, is
getting bigger & fatter every year. At present:
More than 300 million adults worldwide are obese.
Almost half of these individuals live in developed countries
and as many as 23% of American adults are obese.
Obesity results in $100 billion in healthcare costs each
year in the United States.
Obesity results in 300,000 preventable deaths each year
in the United States.
Obesity nearly doubles your chances of developing high blood
Nearly 70 % of cardiovascular disease cases are related
The U.S. Surgeon General has developed a national action
plan to reduce obesity.
National Institute of Diabetes and Digestive and Kidney
National Institute of Health
Center for Disease Control and Prevention
Na tional Women's Health Resource Center
recent study from the journal Public Health reported obesity
as being a greater health risk than smoking, drinking or
poverty. Obesity was more closely associated with major
illnesses and a poorer quality-of-life in comparison to
people that smoked, drank, or lived in poverty. Researchers
found that half of the people who are obese have an additional
chronic condition such as heart disease, cancer or diabetes.
This study was based on a telephone survey of 10,000 Americans
and used only body mass index to assess obesity and overweight.
Regardless, the results are cause for great concern.
must also keep in mind that some individuals may fit into
more than one category, and sometimes even all of the categories.
However, the researchers stated that more people are overweight
or obese than are, collectively, daily smokers, problem
drinkers or living below the poverty line. Of course, being
in more than one category puts your health status at an
even greater disadvantage.
is a huge burden on the health care system now and will
be even more so in the near future. It is a largely a preventable
disease however it is a medical condition in many cases.
This is very unfortunate but it is not something that should
be dismissed as static. You can make a change or you can
help someone make a change toward healthier living. One
of the authors said the survey "demonstrates that public
health officials should intensify their fight against obesity
to levels that at least match the public health campaign
R., and K. Wells. Does obesity contribute as much to morbidity
as poverty or smoking?
Public Health. 115(3): 229-235, 2001.
- WHAT COMES FIRST: THE DIABETES OR THE OBESITY?
this is not a joke, and it's definitely no laughing matter.
Over the past several months, the CB ATHLETIC newsletters
have chronicled the magnitude of both obesity and diabetes
in North America and throughout the world. In addition,
there are also a large number of Internet resources for
more information on either subject, such as www.diabetes.org
The newsletters from the American Diabetes Association have
provided a wealth of knowledge (and many statistics and
research facts in this article).
2 Diabetes (T2-D) is associated with a marked impairment
in the ability of the hormone insulin to stimulate glucose
uptake in skeletal muscle. Most diabetic patients are obese
and have high blood levels of lipids (fats) and glucose
(sugar). Both of these blood levels can contribute to insulin
resistance. Correct insulin is necessary for the cells of
the body to pull sugar (glucose) from the blood to use as
energy. Thus, it is a negative cycle (high blood glucose
leads to insulin resistance and insulin resistance leads
to high blood glucose!). Over the long-term, high blood
glucose levels can lead to damage of the eyes, kidneys,
nerves and heart.
while diabetes is serious, it is largely preventable and
is also possible to control with lifestyle modifications,
although it can't be "cured". Patients can learn to take
care of their diabetes by decreasing their blood glucose
levels through nutritional and exercise interventions and
subsequent reductions in body fat. In fact, with weight
loss, exercise, and better nutrition, many diabetics can
greatly reduce (or eliminate) the need for medications.
Any treatments should be discussed with a medical professional
before changes are initiated.
enough optimism, it's time to look at the hard facts and
the sad state of diabetes in North American (and the rest
of the world).
T2-D affects 140 million people worldwide.
16 million Americans have diabetes.
Diabetes is the 6th leading cause of death by disease in
In America, the total annual cost of diabetes to the nation
is more than $100 billion.
~25% of all Medicare costs are spent on people with diabetes.
Obesity is the most important determinant of insulin resistance.
No one is able to escape the effects of diabetes (i.e. death
of family and friends; financial; health care costs; etc.).
chance of death due to diabetes is increasing primarily
due to cardiovascular disease. More depressing is the fact
that the risk of death increases with lower socio-economic
status, likely because these people are less educated, and
due to the fact that you can buy loads of saturated fat
and sugar for a couple of bucks just about anywhere. Cardiovascular
disease sucks. Having been a spectator of an open-heart
surgery at the foot of the operating table, it is clear
that no one who has the choice would want to go through
that ordeal. Imagine your chest ripped open, your heart
fixed up, and your chest sewn up with wire. Bring on the
most disturbing issue surrounding diabetes is the impact
that it is having in adolescents and in specific ethnic
groups. Nowhere is it more sad or obvious as to what harm
a sedentary lifestyle and a fast food nutritional intake
can have on a person's health than in children. Overweight
children are becoming more common, health problems are greater,
and T2-D is being seen more and more at younger ages. Risk
factors for overweight kids include overweight parents,
high-fat diets, watching too much television, and being
from poor families.
overweight children often simply become overweight adults.
Because it is difficult for people to lose body fat as one
grows older, public health experts hope that preventing
excess weight gain in children will avert health problems
later in life. Researchers at the Centers for Disease Control
and Prevention confirmed that American adolescents are developing
T2-D. However it is difficult to detect T2-D in children
because rarely do they show symptoms (these take years to
manifest). Thus, it is extremely important to initiate educational,
nutritional, and physical activity programs as soon as possible
at all socio-economic levels.
the number of American diabetics increased at least 33%
over the 1990's and as obesity continues to increase, so
will diabetes. Unfortunately, this impacts certain ethnic
groups to a greater extent than others. For example, Native
American Indians have a very, very high number of T2-diabetics
in their communities (3 three times the national average).
African Americans may have an even higher rate of diabetes
(10.8% of all African Americans - 2.3 million). It is hoped
that educating these peoples on nutrition and physical activity
will help combat the disease.
fat consumption has decreased over several decades from
40 % to 34 %, however the rate of obesity has risen from
12 % in 1991 to at least 23% today. This may be due in part
to the vague "official" nutritional recommendations and
the massive fast food industry. The general public believes
in a low fat and high carbohydrate diet, however they don't
know that there are both good and bad fats and good and
fact, some research shows that neither the total amount
of fat or carbohydrate a person consumes can predict diabetes.
Researchers suggest it may not be the quantity of fat or
carbohydrate that you eat, but rather the quality. Improving
the quality of your food intake and monitoring the quantity
will help prevent against overweight and obesity.
et al. (2001a) have written a tremendous paper on the role
of nutrition in diabetes. They found that for carbohydrates,
one should consume more low-glycemic carbohydrates and a
high fiber content. In contrast, everyone should consume
minimal refined flour products to prevent large increases
in blood sugar and insulin after meals.
carbohydrate foods are oatmeal, whole unrefined grains,
fibrous vegetables, apples, and other fibrous fruits, while
breads and sugar based foods (soda, candy, etc.) should
be eliminated. In diabetic individuals, a diet of low-glycemic
carbohydrates can improve blood sugar control and if you
are obese, you should absolutely eliminate all high-glycemic
carbohydrates from your diet. In fact, a meal of high-glycemic
foods does not cause people to feel full, and may lead to
more eating! In summary, this relationship has been established:
High-glycemic carbohydrates develop obesity, and obesity
their thorough review, Hu et al. (2001a) also found that
a high intake of saturated fat and trans-fatty acids likely
promote diabetes. In contrast, an increase in a person's
intake of poly-unsaturated fat and Omega-3 fatty acids could
help prevent diabetes. It is wise to decrease consumption
of saturated fats (animal fats), margarine, butter and hydrogenated
vegetable oils (i.e. the oil that french fries are cooked
in). Salmeron et al. (2001) recommend decreasing your intake
of trans-fatty acids (hydrogenated vegetable oils) by replacing
them with non-hydrogenated polyunsaturated fatty acids will
help decrease your risk of T2-D. One place to start is reducing
your intake of fast food.
replacement, everyone should try to consume more fish oils
and non-hydrogenated vegetable oils (i.e. olive oil). Most
of the research presented is based on association. For example,
in the Netherlands, diets containing a lot of fish are associated
with lower risks of diabetes. Researchers suggest that one
must follow the correct diet for a long time (i.e. make
it part of your lifestyle) in order to see benefits. For
example, fish oils (Omega-3 fatty acids) have benefits for
"cell membranes" and help insulin function properly, however
this will not happen overnight just because you had a salmon
a typical "Westernized" diet should be avoided. All the
negatives (i.e. saturated animal fats and sugars) seem to
be associated with one another (i.e. they are all found
in your typical fast food meal). In reality, everyone should
Decrease animal fat (saturated fats) and hydrogenated cooking
Increase fish and flax oils (poly-unsaturated Omega-3 fatty
acids) and vegetable oils.
Decrease high-glycemic carbohydrate intake. Don't drink
Increase fiber from whole grains
Increase fruit and vegetable consumption
the 2001 ENDOCRINE SOCIETY meeting, alternative treatments
of T2-D were recommended by Arsenis and Goettelman. In this
study, diabetic patients reduced animal protein intake from
2-3 times a day to once every other day (vegetable protein
was substituted) and stopped all consumption of plain sugars.
Patients liked the new diet and the fact that they did not
have to fast, take low calorie diets or receive appetite
suppressants. The metabolic profile of many patients improved
and it even helped some to stop using certain medications.
The authors concluded that the reduction of animal protein
and sugars help to improve the quality of life and metabolic
profile of diabetic patients.
addition to diet, another contributing factor to obesity
is that 60 % of Americans don't get enough activity and
25 % get NO activity. A recent study examined almost 40000
males over the age of 40 and how the amount of TV they watch
relates to their T2-D risk (Hu et al., 2001a). Researchers
showed that more TV was significantly associated with higher
risk for diabetes and that increased physical activity is
associated with less risk for diabetes.
key point is that if people get up and moving that they
may be able to decrease their risk of diabetes. This information
should be applied towards youths as well. In addition, for
obese people, simply losing 5-10 pounds can have a dramatic
positive effect on their health!
inadequate sleep can have an effect on diabetes according
to research from the lab of Dr. Eve Van Cauter. In a study,
subjects that got restricted sleep (< 7h) for 5 nights
had impaired insulin sensitivity (Mander et al., 2001).
It may be due to disruption of bodily functions due to shortened
sleep. Thus, one of the functions of sleep may be to assure
normal blood sugar levels. That's another "Western world"
lifestyle factor that may contribute to diabetes.
a related note, "Excessive Daytime Sleepiness" (EDS) is
becoming more prevalent. This condition is associated with
diabetes and is considered as an important public health
problem because it is a strong risk for public safety. Its
prevalence is estimated to occur in 5% to 15% of the general
to the National Institute Health, 35-40 % of adult American
women and 20-24 % of adult American men are trying to lose
weight at any given time. An interesting story came out
of Philadelphia last month. Philly was rated the fattest
city in the USA for January of 2000 and the mayor urged
the city to lose weight. The city has taken the challenge
and this year sits at 3rd, while Houston is now the fattest
in the USA. On a whole, obesity and diabetes are more prevalent
in the Southern United States!
a study presented at the American Diabetes Association conference,
diabetic patients have the greatest improvements in symptoms
after following a program that combined a proper exercise
and diet approach (Alpizar et al., 2001). Obesity remains
the major obstacle to the achievement of satisfactory glycemic
control in T2-D and often limits management of cardiovascular
risk factors. After nutritional education and guidance,
as well as an increase in daily physical activity, modest
weight losses and improved diabetic factors were noted (Reynolds
et al., 2001). Again, these stress the need for education
you are active, if you eat a variety of healthy foods (natural
produce, lean meats, un-refined grains), and if you are
of a healthy weight, than the fear of diabetes and obesity
should be minimal. When asked how to avoid diabetes, Dr.
Ronald Kahn said, "Stay thin! If you are not, get thin!"
After all, obesity is the most important determinant of
active people of a healthy weight, it is not unrealistic
to include the odd "Western" meal in your weekly schedule
without causing panic. However, the consistent intake of
a high-sugar, low-fiber, high-saturated fat diet, along
with a daily sedentary living pattern precludes people to
the awful diseases that are diabetes and obesity.
M., et al. Effectiveness of an Exercise Program and Diet
Plan in the Control of DM2
Patients. American Diabetes Association, 61st Annual Conference,
F., et al. Diet & risk of Type II diabetes: the role
of fat & carbohydrate. Diabetologia 44:
F., et al. Physical Activity and Television Watching in
Relation to Risk for Type 2 Diabetes
Mellitus in Men. Arch Intern Med. 161: 1542-1548, 2001b.
B., et al., Short Sleep: A Risk Factor for Insulin Resistance
and Obesity. American Diabetes
Association, 61st Annual Conference, 2001.
L., et al. Lifestyle intervention reduces multiple risk
factors in obese patients with
poorly controlled insulin-requiring type 2 diabetes mellitus.
Association, 61st Annual Conference, 2001.
J., et al. Dietary fat intake and risk of type 2 diabetes
in women. Am. J. Clin. Nutr.
73(6): 1019-1026, 2001.