Obesity and Diabetes: It Doesn’t Have to Be.

In October 2008, the U.S. Centers for Disease Control reported that the incidence of newly diagnosed diabetes nearly doubled in the last 10 years. The human and economic cost of diabetes, in the U.S. and around the world, is rapidly becoming the most important of all public health problems. The good news is that diabetes, along with most other chronic degenerative diseases, can be prevented through modest lifestyle changes. Knowing the risk factors and learning how to reduce them can restore active and healthy lives to millions.

There is no chronic degenerative disease more epidemic today than type 2 diabetes. And yet it is among the most easily prevented of all diseases. That’s because the explosion of diabetes we see today is largely the result of two trends: rapidly increasing obesity and a dramatic drop in daily physical exercise. Those trends can be reversed and the incidence of obesity, diabetes, and their complications greatly reduced.

The reason I can say that with confidence is the result of an important study by the Diabetes Prevention Program, a major clinical trial performed by the National Institutes of Health. All 3,234 study participants in the study were overweight and had impaired glucose tolerance, recognized risk factors for diabetes.

One-third of the subjects took metformin, the most frequently-prescribed diabetes drug, twice a day, one-third received a placebo twice a day in place of the drug, and one-third received training in diet, exercise, and behavior modification.

The goals of the lifestyle intervention training were to:

• achieve and maintain a weight loss of 7 percent with healthy eating and increased physical activity, and
• maintain physical activity at least 150 minutes a week with moderate exercise, such as walking or biking.

Not what you would consider a radical change in lifestyle.

The results, however, were radical. While metformin was found to somewhat reduce the risk of diabetes in persons at high risk, lifestyle intervention was far more effective. Overall, healthy diet and exercise—without any drugs—reduced the likelihood of diabetes by nearly two-thirds. Of course there also were no negative drug side effects from eating right and exercising, only additional benefits that can last a lifetime.

These striking results tell us that millions of high-risk people can use diet, exercise, and behavior modification to avoid developing type 2 diabetes. Through nothing more than awareness of risk factors, and individual preventive action, families all around the world can be spared the burden of diabetes and its debilitating complications.

Further reading:
Diabetes Prevention Program Research Group. Reduction in the incidence of Type 2 diabetes with lifestyle intervention or metmormin. N. Engl. J. Med. 346(6):393-403. 2002.

Molitch, M.E., et al. The Diabetes Prevention Program and Its Global Implications. J. Am Soc Nephrol. 14:S103-07. 2003.

Kirtland, K. et al. State-specific incidence of diabetes among adults—participating states, 1995—1997 and 2005—2007. MMWR 57:1169-72. 2008.