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Blog: 'Carrot' or 'stick' for diabetes

I read the Independent Diabetes Trust Newsletter from time to time, when it is delivered and find that often it offers a sometimes-controversial viewpoint about aspects of diabetes that may be in the news.

One such point was about the publicity during Diabetes Week that suggested that the rise of obesity was responsible for the escalation in the development of type 2 diabetes. What do you think is really the case? The writer of this article suggested that we should not blame individuals, but rather take into consideration the changes in lifestyle and foods consumed over the past 100 years or so. Is the rise in obesity and overweight in any way related to the significant rise in type 2 diabetes? The majority of my patients who have type 2 diabetes are overweight or obese, but not all of them, and for a number there is a strong hereditary factor.

Apparently, a woman rang the Insulin Dependent Diabetes Trust (IDDT) very angrily stating that she was not overweight nor ever had been, but there was a strong family history of type 2 diabetes. How would this woman feel if she was also of South Asian origin, where there exists a much lower threshold for developing type 2 diabetes, so the prevalence of the type 2 diabetes is much higher even at a seemingly normal height, weight and waist circumferences in that population?

On the other hand I quite agree with the author of this article (Jenny Hirst) in how we as a society deal with the problem. Should we put health warnings on drinks and other foodstuffs loaded with sugar, just as there are on cigarette packets? After all, obesity may now have overtaken cigarette smoking as the greatest danger to both life and health. Do we explain to our patients that some of the foods they eat are really harming them and their future health? How much time do we give to reminding them of this; and do we refer our newly diagnosed patients with type 2 diabetes to attend a local structured education course, where they can receive such a wealth of information on this subject?

In an earlier blog this year, I raised the topic of reducing sugar in our diets, and mentioned the increased risks that the South Asian population have to live with. We need to address these dietary and lifestyle issues, which have taken the whole world by storm, not just the USA and UK. We each need to play our part in educating wherever we can, and lobbying appropriate organisations regarding education on healthy eating; even providing opportunities for teaching people to cook healthily but at the same time, economically.

We have national vaccination programmes to protect our children as they grow, how about a national programme for healthy eating? We need to make healthy eating attractive, so that people want the benefits and become keen to make the changes. Not only does eating healthily and taking plenty of physical activity reduce our risks of developing type 2 diabetes, but also reduces our risk of developing cardiovascular disease, and at least 10 of the more common cancers are also thought to be linked to poor diet, and let's not forget that conditions as Alzheimer's disease may be linked to poor diet and low levels of physical activity. 

Should we be using both the “carrot” and also the “stick” approach at the same time? We need to incentivize people, “how much better they will feel”; reduction in various health issues- joint problems, skin disorders, energy levels etc. Is healthy living attractive enough, somehow we must present it in that way?

Please respond to this blog, I can know then if it is being read when people start commenting or criticising what I have written. My view is just one, and it would be good to have discussions about issues raised.