Prevention of Diabesity as Health Care Policy
to the Journal By Radomir Stevanovic, MD
is the latest appellation of the constellation of signs, symptoms, and
complications linked to diabetes, obesity, hypertension, and elevated serum lipids.
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.
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
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!
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.
measures can include:
calorie intake through calorie counting and the reduction of portion sizes at
home and in restaurants;
diabetes education to individuals who are glucose intolerant (an ounce of prevention…);
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
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.
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.
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.