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In the dark about diabetes

Obesity is a leading risk factor for diabetes, yet many overweight people appear to be in the dark — or in denial — about their odds of developing the disease, according to a new survey by the American Diabetes Association.
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Obesity is a leading risk factor for diabetes, yet many overweight people appear to be in the dark — or in denial — about their odds of developing the disease, according to a new survey by the American Diabetes Association. Just over half of overweight respondents identified excess weight as a culprit. And of those who did, most maintained that they personally were not at risk nonetheless.

“Many of them did not perceive themselves at risk even though they knew being overweight is a risk and they themselves are overweight,” says Martha Funnell, a nurse and diabetes educator at the University of Michigan and past-president of health care and education for the ADA.

In the telephone survey of 600 American adults, conducted in August, 60 percent of all respondents cited being overweight as a risk factor for diabetes.

Half of those polled were identified as overweight or obese. But just 56 percent of them said excess weight increases the odds of diabetes — and 59 percent of these respondents said they were not at personal risk.

“I think people think bad things happen to other people, not to them,” Funnell says.

Another reason overweight people may not realize the threat is because their relatives aren’t affected, she says.

One in three may be affected
Unfortunately, though, diabetes is striking a rapidly increasing number of Americans — family history or not — and the rise is closely paralleling the worsening obesity epidemic.

An estimated 17 million Americans have diabetes, mostly the type 2 form. Another 16 million more people have “prediabetes,” which puts them at risk for the full-blown disease.

If current trends continue, about one in three children born in the year 2000 may develop diabetes during their lives, predicts a recent study in the Journal of the American Medical Association.

“We were quite surprised by such a high probability,” says study author Dr. K. M. Venkat Narayan, chief of the diabetes epidemiology section at the Centers for Disease Control and Prevention.

Diabetes rates have increased by about 50 percent over the last decade, he says, largely to to America’s love of food, and lots of it, and lack of exercise.

“We do think the increase in type 2 diabetes is driven by the epidemic of obesity,” Narayan says.

Nearly two-thirds of Americans are now considered overweight or obese. And about 90 percent of people newly diagnosed with type 2 diabetes fall into these weight categories, according to the ADA.

Type 2 diabetes occurs when the body becomes unable to use insulin properly or cannot make enough insulin to maintain normal blood sugar, or glucose, levels. Insulin, a hormone produced by the pancreas, is needed for cells to take up glucose and use it for energy. Doctors believe excess body fat impairs the ability of insulin to do its job.

Diabetes can lead to heart disease, stroke, blindness, kidney failure, amputations and an early death, especially when the disease is not properly treated.

Modest efforts, big benefits
But the good news is that modest lifestyle changes can have a substantial effect.

“We need to get the message out that you really can do something,” Funnell says. “Losing just 10 to 15 pounds can really make a difference.”

That finding comes from the landmark Diabetes Prevention Program study of people deemed at high risk for type 2 diabetes because they were overweight and already had impaired glucose tolerance, or prediabetes. Results showed by losing just 5 to 7 percent of body weight — 10 to 15 pounds — and increasing physical activity, such as brisk walking, to 30 minutes a day five days a week people could delay or prevent the onset of diabetes by about 60 percent. The oral diabetes drug metformin also helped but not as much as lifestyle change.

To get the word out that diet and exercise can have big benefits, the ADA recently launched its Weight Loss Matters campaign, in which the group has distributed brochures to physicians’ office to educate patients about the link between obesity and diabetes and offer tips for losing excess pounds.

But evidenced by America’s expanding waistline, getting people to exercise and eat healthfully is no easy task.

“People need to accept that these things must become part of our lives or our lives will be shortened,” says diabetes specialist Dr. Diana McNeill, an associate professor of medicine at Duke University.

Such efforts not only aid in prevention but may also help some diabetics to avoid a lifetime of medication.

“Lifestyle modification makes a difference,” says McNeill. “But that’s the hardest part of the treatment. It’s a ton easier for me to hand you a prescription.”