JAMES ROSENZWEIG AND OSAMA HAMDY

Op-Ed: The Obesity and Diabetes Epidemic

By James Rosenzweig and Osama Hamdy | August 13, 2005

IN THE PAST YEAR there have been improvements in the nation's battle against the epidemic of obesity. The MyPyramid, an updated version of the USDA's Food Guide Pyramid first unveiled 13 years ago, replaces a one-size-fits-all approach with an ''individualized approach to improving diet and lifestyle." Combined with new dietary guidelines issued earlier this year, the government is trying to help Americans make healthier food choices.

While the effort is to be applauded, it's not enough.

The MyPyramid and dietary guidelines are effective for the 35 percent of the general public who are of a healthy weight range. But for the two out of every three Americans who are overweight or obese, the effort seems extremely deficient – especially given the prevalence of type 2 diabetes, a disease strongly related to obesity, which has reached epidemic proportions. If we are truly serious about the obesity and diabetes problems, it's time to address the needs of more than 50 million Americans: those with type 2 diabetes who are overweight or obese, and the 41 million more who have pre-diabetes and are at high risk for developing diabetes and devastating complications that include cardiovascular disease.

Maintaining a healthy weight and lifestyle is important because many people who have diabetes are unaware they have it. Unfortunately, diabetes-related complications, which are quite serious, often begin before type 2 diabetes is detected. When patients are first diagnosed with diabetes, an estimated 17 percent already have cardiovascular problems, the leading cause of death in nearly 75 percent of our patients.

Americans need recommendations that are sustainable and easy to follow. Based on current studies, we at Joslin recommend that most Americans who are overweight or obese with type 2 diabetes or at risk for diabetes reduce their overall energy intake by 250-500 calories per day; reduce energy intake from carbohydrates to approximately 40 percent of daily caloric intake; increase the amount of protein to 20 to 30 percent of daily caloric intake, unless they have kidney problem that requires less protein intake; and increase their amount of fiber intake to at least 20-35 grams per day.

But that's not all.

It is easy to tell people with diabetes or pre-diabetes to lose weight and it's critical to educate overweight Americans about the importance of physical activity to improve their health, but there are no quick fixes. They need a long-term healthier lifestyle that combines an effective nutrition and efficient exercise plan.

We also need better programs, not just guidelines, for our children. For example, the Special Supplemental Nutrition Program for Women, Infants and Children, better known as WIC, provides eight million low income families with vouchers for food based on a plan that hasn't changed significantly since 1974. We support the National Academy of Sciences in urging WIC to offer vouchers that at least match current nutritional research.

The need for children to get good nutrition is more important than ever. Type 2 diabetes had been considered an adult disease but is increasingly prevalent among children and adolescents, particularly in American Indians, African Americans, and Hispanic/Latinos, according to the National Institutes of Health. It is no surprise to see this new serious phenomenon when 16 percent of American children and adolescents are currently obese.

We certainly need to help students make better food choices at schools. We need to offer healthy lunches and kick fast food chains and snack and beverage machines off campus. This will be difficult because many cash-strapped communities receive financial benefits for having these restaurants and machines on campus.

But it is a step that must be taken to stem the obesity and diabetes epidemic. The cost of bad nutrition to society is too high to ignore and will keep climbing.

A major risk factor for heart disease, stroke and birth defects, diabetes affects virtually every tissue of the body and shortens average life expectancy by up to 15 years. Diabetes spares no group: men and women, the young and elderly, and every racial group is affected. The emotional toll and financial costs of diabetes and its complications to our health care system is already an estimated $132 billion annually in terms of healthcare costs and lost productivity. More than one of every four Medicare dollars is spent on people with diabetes. That number will get larger still if the millions of overweight people with type 2 diabetes and the additional 41 million Americans with pre-diabetes don't have appropriate recommendations to guide them in making healthier lifestyle choices.

Dr. James Rosenzweig is director of Joslin Diabetes Center's Disease Management Program and assistant professor of medicine at Harvard Medical School. Dr. Osama Hamdy is clinical director of Joslin Diabetes Center's Obesity Program and instructor of medicine at Harvard Medical School.