Opinion: With the numbers of people living with diabetes in Ireland expected to increase, we need a similar bold approach to the prevention of obesity to stop its onward march.
The incidence and prevalence of type 2 diabetes is increasing worldwide and is the most common form of diabetes particularly affecting those over 50.
Recent Irish figures from the Institute of Public Health found that diagnosed type 2 diabetes prevalence was 8.4% in people aged 50 years and over. When I was a student 40 years ago, this figure was closer to 1%.
By 2020, the numbers of people living with diabetes in Ireland is expected to increase by 30% from 2010 figures.
The cause of this is very clear. We are becoming increasingly obese as a population and the relationship between obesity and diabetes is well established. 90% of people with diabetes have type 2 diabetes which is directly related to obesity.
Schulz et al commented that "the increasing prevalence of obesity - fuelled by excessive calorie intake, sub-optimum dietary quality, and sedentary lifestyles - is driving this epidemic". Thus we are sleepwalking our way as a society into a growing epidemic of diabetes.
This epidemic is threatening to bankrupt our health care systems within a generation as increasing numbers of patients are managed with increasing numbers of increasingly expensive drugs. The diabetes drugs bill in the British National Health Service (NHS) for example is estimated to rise from almost £10bn currently to a predicted £16.9bn by 2035.
From RTÉ 2FM's The Nicky Byrne Show with Jenny Greene, Marc Farrelly spoke with Nicky and Jenny about 'Bittersuite - The Rise of Diabetes', a documentary which aired on RTÉ 1 on November 14th to mark World Diabetes Day.
It seems to me that the current obesity/diabetes crisis is similar to the typhoid epidemic which pervaded America and Europe in the late 19th century.
Public health measures backed by legislation won the day here. As a result of the introduction of clean water, the rate of death from typhoid fever fell from 80 per 100,000 population in 1890 to 7 per 100,000 population in 1918. This population-based preventive approach treated the disease far more effectively than individual patient management.
In my opinion, we need a similar bold approach to the prevention of obesity to stop the onward march of diabetes. This legislation enabled public health approach must take precedence over the so called medical model which focuses on the individual rather than society as a whole.
In other words, we need to adopt a similar approach to the "clean water" act of the late 19th century, only in this case it is an anti-obesity act. So what can be done?
Firstly, for our patients already diagnosed with type 2 diabetes, there needs to be a much greater focus on lifestyle measures to treat the condition. There is an abundance of evidence that this approach is effective. No drugs are involved.
Lifestyle measures may arrest or even reverse the progress of type 2 diabetes in the individual patient. Many lifestyle measures have the added advantage of not costing any money and not having any unpleasant drug side effects such as nausea or low blood sugar. A programme of exercise and diet can also have other benefits such as reducing blood pressure, achieving weight loss and elevating mood.
From RTÉ Radio 1 CountryWide, Type 2 diabetes is on the increase in Ireland & many of us would not know we are developing it until symptoms hit us. A simple blood test for diabetes is really simple, quick & painless & joining Marty in studio is a highly professional team, Sinead Powell is a dietitian from Cork & her assistant is, a turkey!
Has this been shown to work at a population level? Yes it has.
After the downfall of the Soviet Union in the 1990s, a profound economic crisis developed in Cuba as a result of a serious falloff in financial support.
Severe shortages of food and petrol resulted in a widespread decline in dietary energy intake and increase in energy expenditure (mainly through walking and cycling as alternatives to mechanised transportation). Rapid declines in diabetes and heart disease accompanied an average population-wide loss of 5.5 kg in weight.
Following resolution of the crisis, a rebound in population weight occurred and by 1995 there was a return of the rates of diabetes and heart disease to previous levels. These figures show the enormous potential public health measures have in reducing the rates of diabetes and the resulting complications including heart disease.
So what can we do tomorrow? We need to develop measures, backed by legislation, that include:
1) Appropriate population planning: Ensure that residential development takes place near to shops, schools, churches and places of entertainment. Adequate policing and infrastructure needs to ensure safety of those walking and cycling. This reduces reliance on cars and encourages people to walk and exercise daily as an integral part of their daily life.
Other measures include 'walking bus' schemes for schoolchildren, encouraging public transport, developing 'park and ride' facilities as well as pedestrianisation of cities. We must encourage exercise as part of the daily routine and not something one does in a gymnasium if one has spare time. This is known as "active commuting" and has been shown to reduce death rates. It is also much kinder to the environment.
2) Introduce a 'fat tax': That would make high-energy, high-fat foods more expensive and would subsidise the cost of healthier foods such as fresh fruit and vegetables. The 'plastic bag' tax is evident of the effect that such a judiciously-placed tax can have on the habits of a community.
3) Educate our children on the benefits of a good balanced diet: This education is especially important in the lower socioeconomic groups where rates of obesity and diabetes are higher.
4) Making physical exercise compulsory in schools: The alarming increase in the prevalence of obesity in children also needs to be addressed as Type 2 diabetes due to obesity is increasingly being seen at younger ages.
It is now time for brave and definitive action.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ