Oct 25 2011
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Living in a Sugar Nation: Can We Win the Battle Against a Silent Killer?

By Najaf Ahmad, MPH, Communications Associate, Robert Wood Johnson Foundation Human Capital Portfolio

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Walking through Barnes & Noble recently, a book on the “New Arrivals” rack stopped me in my tracks. By now you may know about My Sugar Obsession. So despite being in a rush, I was immediately drawn to Sugar Nation.

Imagine reuniting with a father you haven’t seen in years, finding him in an unrecognizable condition—a “human body in the process of cannibalizing itself”—on death’s door with a missing limb. Author Jeff O’Connell begins with this moving story of how he learned that his estranged father was slowly dying from the ravages of type 2 diabetes.

Despite having learned of his father’s leg amputation weeks earlier, O’Connell—former editor-in-chief at Muscle & Fitness magazine and executive writer at Men’s Health magazine—was certain he had nothing to worry about. He worked out, was lean and appeared healthy. His thin physique didn’t fit the stereotype of someone predisposed to developing type 2 diabetes.

A sobering visit with his doctor shook O’Connell to his core. He was diagnosed with pre-diabetes and headed down the same path as his father. Rather than accepting this fate though, he embarked on a mission to fight back against the enemy lurking within him. In doing so, he unearthed crucial information on how lifestyle factors influence diabetes.

More interestingly, he discovered the troubling manner in which health care providers are (or are not) responding to this burgeoning problem, going so far as to say that many “seem clueless when it comes to diagnosing this disease, let alone treating it.”

Although genes play a prominent role in predisposing someone to type 2 diabetes, lifestyle is a major influence. O’Connell underscores how type 2 diabetes stems from “the sum total of a very long trail of personal choices, made over a lifetime.” We pay a heavy price for our love affair with sugar, as massive quantities from processed foods shock our bodies. It shouldn’t be surprising then that one in three adults in the United States now has a blood sugar abnormality that predisposes them to diabetes-related complications such as heart disease, kidney failure and blindness. Sadly, many do not know they are affected until they develop these complications.

The rampant rate of type 2 diabetes is taking a toll on our health care system. O’Connell notes that the “U.S. diabetes tab for only direct medical expenditures comes to nearly $120 billion a year. Throw in lost productivity—$58 billion worth of missed workdays, lackluster job performance, and the lost input of those who can’t work at all any longer—and the total price tag rises to $178 billion.”

So what are health care providers doing about this? The book provocatively suggests that, for a variety of reasons, many are doing very little.

Many doctors don’t deliberately withhold dietary information—rather they are not well versed in nutrition themselves. O’Connell cites a recent study showing that fewer than one-third of U.S. medical schools require any instruction in nutrition. The National Academy of Sciences recommends a mere 25 hours of nutritional instruction over the course of four years of medical school, and even this low bar is infrequently achieved. And even when they are knowledgeable about how lifestyle influences disease progression, managed care or other influences may still deter physicians from counseling patients on diet and physical activity. “If you spend ten minutes with a patient, how are you going to fix anything?” asks one doctor. Physicians are even less likely to provide advice on diet and exercise if they believe patients will not follow it.

Patients suffer gravely as a result—especially those in underserved communities like Ruth Tolbert, a 66-year-old African American grandmother featured in O’Connell’s book. She didn’t know diet could help prevent the diabetes she believed she was destined for since both her parents suffered from it. “Now I do, but it’s too late,” she says. Despite suffering a stroke and related complications, Ruth drives 55 miles to escape the lack of “good markets or food stores” in Tchula, Mississippi, to Jackson, where healthier food options exist. As one expert in the book notes “This disease is environmental and economic. Unless we do something about our social disparities, we’re toast as a nation when it comes to type 2 diabetes”.

Many believe that disease management programs can help patients with diabetes—especially those from underserved communities—gain control of their conditions and reduce complications. But even such disease management needs to be developed and implemented in an intensive, well-thought out way. Just a few weeks ago, Robert Wood Johnson Foundation Health & Society Scholar Dominick Frosch showed that an intensive telephone-based intervention strategy was insufficient to change diabetes outcomes. Frosch noted that even this degree of effort is simply not enough for those struggling through enormous daily challenges.

O’Connell recognizes the need for larger, structural interventions and stresses the importance of interdisciplinary approaches to disease management. “It takes an ongoing effort, and physicians aren’t always the best people to do that. It needs to be a team of exercise physiologists and nurses and dieticians and other specialists. But most communities don’t have a system in place to help people adhere to a diet-and-exercise program.”

Like Jeff O’Connell, there are countless people who are on the road to type 2 diabetes and the terrible complications that come with it. Some may know it and aren’t getting the support they need to change course. Others may suspect it and be avoiding a diagnosis. Still others have no idea because they aren’t getting preventive or primary care. According to O’Connell, one in four diabetics is in the dark about his or her condition.

In a recent Q&A for O Magazine, O’Connell noted that writing his book left him incredibly optimistic that a person can beat diabetes on an individual level. However, he is also “incredibly pessimistic that we as a society will be able to prevail against diabetes.” It’s sad to think this may well be true—unless providers do more to recognize and treat the condition and create novel interventions to improve outcomes of this devastating disease.

Tags: Diabetes, Health & Health Care Policy, Health & Society Scholars, Human Capital, Medical, Nursing & Dental Workforce, Nutrition, Publications, RWJF Leaders, Research, Research & Analysis