Map of life expectancy at birth from Global Education Project.

Monday, April 30, 2012

Civilization and its Discontents

You have likely heard about a new study that finds that treatment of Type 2 diabetes in juveniles is very likely to fail. Here is the linked editorial in NEJM in which David B. Allen make a succinct statement of our doom:

[T]his is the essential, maddening conundrum of the epidemic of type 2 diabetes — collective failure to adhere to a lifestyle healthy enough to prevent the disease. A critical point is that the participants in the TODAY study were not adults, but youth immersed from a young age in a sedentary, calorie-laden environment that may well have induced and now aggravates their type 2 diabetes. Fifty years ago, children did not avoid obesity by making healthy choices; they simply lived in an environment that provided fewer calories and included more physical activity for all. Until a healthier “eat less, move more” environment is created for today's children, lifestyle interventions like that in the TODAY study will fail.

Please note that 20 years ago, nobody had ever heard of Type 2 diabetes in children. As a matter of fact, what we now call Type 2 diabetes used to be called Adult Onset diabetes. Nowadays, however, Type 2 diabetes is just as prevalent in children as Type 1 diabetes (an unrelated autoimmune disease with similar symptoms) which used to be called Juvenile Onset diabetes. This is a public health catastrophe that threatens all the gains we have made in life expectancy and health, and threatens every strategy to contain health care costs.

Yeah yeah, I keep saying it. We keep hearing from conservatives about personal responsibility and how people who develop health problems because of their own bad behavior don't deserve to have the rest of us pay for their health care. But the truth is that our behavior is a function of our social and physical environment.

We evolved to eat whatever food was available because there might not be any tomorrow; and to rest when we could because chances were rare and almost all the time, we had to keep moving if we wanted to keep eating. The human organism is adapted to an environment in which it no longer lives. The result is, many of us get fat. This isn't because we are irresponsible or gluttonous or slothful -- or rather, of course we are gluttonous and slothful, that's how we are made. It's not our fault that we have these faults, it's our nature.

So what is to be done? We can't just target and treat individuals who have this problem. We urgently need to change the cultural, physical and economic environment. There are a lot of ways to do that, first of all by defining junk food and sugary beverages as something other than food, and treating them accordingly. No matter how much the purveyors of this garbage pay corporate think tanks and phony scholars to yell about the Nanny State and personal freedom. What they mean is their freedom to rip us off and kill our children. 


Anonymous said...

we won't solve the diabetes type 2 problem until we solve the carbohydrate eating problem. we used to eat fat...and then reduced it and changed to more sugar and carbohydrates...and then the obesity epidemic really took off. A breakfast of juice, cereal and milk is just three types of protein/fat to satisfy and keep away from sugar crashes.

Cervantes said...

Good point, with a quibble. Fruit for breakfast is okay I think -- it's not protein or fat but it contains fiber which slows absorption of the sugar (which is not that much anyway) and hence eliminates the glycemic spike. Similarly, a high fiber (whole grain) cereal is a better choice, although whole wheat toast would be even better. Low fat milk is good too. But still, in the end, even a good quality meal will make you fat if you eat too much.

Anonymous said...

in reply, juice is not fruit..., low fat milk is just sugar water, whole grain is marginally better, but what would be a good meal is full fat greek yogurt, eggs, grass fed beef...please look at the paleo movement - chris masterjohn is a good reference, as is Marks daily apple...the SAD (Standard American Diet) is just wrong!