Diabesity: Reaching the Crossroads

There is a strong correlation between obesity and diabetes. There are approximately 19 million type 2 diabetics in the US, of which 80% are obese. These 15 million obese type 2 diabetics represent roughly 20% of the 76 million total obese adult population in this country.

If both diabetes and obesity metaphorically highlight two paths of destruction, then insulin resistance would be the intersection where these paths converge. How does insulin resistance and the onset of type 2 diabetes relate clinically to obesity? First, the enlarging fat cells secrete hormones and other factors that promote insulin insensitivity. Second, obese patients tend to eat foods with high glycemic index ratings (quickly converted to blood sugar) that shoot up insulin levels. These factors mixed with a cup of genetic predisposition for insulin resistance and a tablespoon of sedentary lifestyle (inactive muscles not using the consumed energy) create the perfect recipe for pre-diabetes and type 2 diabetes.

There is also a chicken or the egg theory that questions whether diabetes can also promote obesity. Insulin accelerates energy storage into fat. High levels of insulin, combined with large amounts of foods with high glycemic index ratings, leads to elevated levels of fat storage. While this theory is not evidence-based, it does emphasize how intertwined the obesity and diabetes epidemics are.

Influences and trends – the perfect storm is brewing

Our eating habits are based on the past. The American culture long has centered around having three full meals per day. As the productivity of farms increased, so did the volume that people consumed. By the late 1890s, it was the norm for the middle to upper class to even have 15-course dinners.

It is not as if these meals were fat-free either. Growing up on a farm in the early 20th century, all parts of the slaughtered hog were consumed. The butter was real, the milk was whole, and the flavor came from lard. Why was it that diabetes and/or obesity were not problems like they are now? The full answer involves genetic, physiological, psychological, sociological, and economic factors.

Cheap food, more choice and portion size. The technological advances over the last half-century on the production, transportation, preservation, and preparation of food have dropped prices by 12%. Along with the improved convenience, variety, and taste of fast food, this makes it too difficult to resist, especially for struggling, full-time working families that do not have two hours a day to cook meals. The cherry on top would be the societal perception of “value” weighing heavily toward larger volume and portion size.

Sedentary lifestyles. No longer in a farming economy, with the increased number of desk jobs and lengthened commute time, people now have to pay a premium to get physical activity through fitness center memberships. In addition, because of the affordability and improved lifestyle of living in more rural areas, people are spending more time in cars commuting. After arriving to the workplace, the progression of the computers and the Internet has made it norm to sit behind the screen all day. After commuting back home, the entertainment trends have also been affected by the Internet, video games, and TV. Budgeting time to exercise costs time and money (health club memberships and sporting good equipment).

Childhood obesity is a problem. Childhood obesity is also presenting itself to be an unprecedented problem as well. In 2003-2004, approximately 12.5 million children and adolescents were overweight in the US alone. In 2007, 22 million children under the age of five years were overweight worldwide. A few decades ago, junk food was not as available for kids to consume, and kids played more sports and games physically instead of through a video game console. It is estimated that 30% of children eat fast food daily, and that teens consume two times the recommended sugar intake (with 44% being from soda).

Peer pressure (or lack thereof). A compounding factor that has taken the spotlight in more studies is the socially “contagious” phenomena. A person’ chance of becoming obese is much higher if they have a close friend who is obese. Societal norms seem to have a much larger influence than researchers had once thought. What one eats, how much they eat, and how physically active they are depends heavily on the people in their environment. As more people become obese, the less pressure there is to not be obese.

Evolution plays its part, genes matter. Genetic makeup does play a large role in fat storage. Our ancestors lived through cycles of feast and famine. The ones who survived were the ones who could store large amounts of energy to get through weeks without any calorie consumption. Unfortunately, survival of the “fittest” did not lead to our generation being physically fit. Some individuals have a genetic makeup to pack on pounds and therefore, are more prone to be obese.

Motivated by profit margins is just satisfying a basic need. It’s business as usual. Food and beverage companies are doing everything they can to satisfy their customers. Biologically, we crave sugar, salt, and fat. Americans spend $61 billion on soda and $30 billion on pizza every year. We consume about 2 to 3 pounds of sugar per week. The diabesity perfect storm is brewing.