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more articles by Stevanovic, Radomir D. , MD  |  author's bio

Prevention of Diabesity as Health Care Policy

Special to the Journal By Radomir Stevanovic, MD


Diabesity is the latest appellation of the constellation of signs, symptoms, and complications linked to diabetes, obesity, hypertension, and elevated serum lipids.


We can think of diabesity (also know as metabolic syndrome) in the context of a medical paradigm (one patient at a time) or in the context of a social paradigm (a population at a time). Each paradigm brings with it a specific set of tools that can be used to address the difficult issue of lifestyle change.


We can think of diabesity as the price we are paying for our success as a species. Indeed, the numbers affected are staggering: it is a worldwide epidemic at the center of which is a caloric intake out of proportion with needs, and a sedentary lifestyle. According to statistics from the World Health Organization, there are over 170 million people with diabetes, and the numbers are set to double within the next 20 to 25 years. For example, it is estimated that by 2030, India will be the “diabetes capital of the world” with over 70 million diabetics. At that rate, any health care system and economy are set to be overwhelmed.


What are we to do? The answer is quite simple: we must integrate lifestyle changes in the routine of daily life. Simple solutions are, however, often the most difficult and complex to carry out because they address fundamental tenets of our lifestyle, involve social structure, the economy, and might include our giving up some ease-of-life gains. But change, we must!


Around the world a number of countries are adopting designs for cities and common spaces that integrate lifestyle changes into every day life. For example, in Louisiana, cities rebuild after the Katrina devastation are incorporating increased energy expenditure and promotion of an active life style, by decreasing dependence on cars and increasing physical activity (walking). This led to creation of traffic-free zones in the centers of towns and parking lots that are removed from shopping centers.


Other measures can include:

1)     Decreasing calorie intake through calorie counting and the reduction of portion sizes at home and in restaurants;

2)     Offering diabetes education to individuals who are glucose intolerant (an ounce of prevention…);

3)     Offering community-based diabetes education and nutrition programs in places where people congregate, such as churches or schools, because these locations are typically closer to home;

4)     Eat diets rich in foods whose fiber content delays and decreases glucose absorption and cholesterol. Aside from oats, whose beneficial effects are widely publicized, there are a number of other fiber containing foods that have a similar effect, such as the cactus leaf: Nopales, a staple of Native American and Mexican diets.


To foster ownership of change, solutions will require a concerted economic, political, and legislative will, with the development of paradigms that will be both beneficial to populations and economically sound. Given the impact of diabesity on our patients’ health, health-care costs, and its potential effects on the economy as a whole, the health-care industry should be a very active participant in such a change. Because awareness of imperatives and consequences are greatest at the local level, change is best started there.


Given our love affair with mobility, modernity, consumerism and immediate gratification, change is likely to be arduous. But change we will, once economically sustainable paradigms are developed. To loosely paraphrase Chief Seattle: Health, the economy, and politics are brothers after all! Certain hormonal aspects of diabesity resemble those linked to stress or hybernation, hence survival. Perhaps Western Civilization will start living again, once we will do that for which our bodies have been designed to: spend the energy to move and live.


Dr. Stevanovic is board certified in internal medicine and has fellowship training in endocrine and hypertension research. He is a member of the medical staff of Cayuga Medical Center, holds the title of Assistant Professor at Weil-Cornell Medical School, and is in private practice, where he can be reached at (607) 266-9100. He is fluent in French, Spanish, and Serbo Croatian and has working capability in all Romance and Slavic languages, as well as German.





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