Obesity

The USA ranks third in the global prevalence of diabetes, preceded only by India and China. About 7% of the population has diabetes. A third of the total number of people with the condition is believed to be undiagnosed and therefore not receiving treatment to reduce the risk of disabling and life-threatening diabetes complications. The economic costs of diabetes are enormous – estimated at 132 billion USD in 2002. The mission of the US National Diabetes Education Program (NDEP) is to reduce diabetes-related illness and death.

Children around the world are becoming increasingly vulnerable to overweight and obesity. The International Obesity Taskforce estimates that around 45 million of the world’s school-age children are obese – about 3% of the population of children under 5 years old. It is widely recognized that the modern transformation of lifestyles, including widespread sedentary behaviours and dramatic increases in the consumption of foods that are high in fat and sugar and low in nutrients, are behind the pandemic of obesity-related conditions, including type 2 diabetes.

Typical diets for people with type 2 diabetes limit carbohydrates, reduce calories to facilitate weight loss, and limit saturated fats to reduce cardiovascular risk. These dietary changes are logical and sometimes helpful. For many people, however, this sort of change leads to no more than modest weight loss and a small improvement in blood glucose control. In this article, Neal Barnard looks at evidence to suggest there might be a more effective nutritional approach to prevent or manage type 2 diabetes.

Many children around the world are starving or undernourished. In contrast, obesity and type 2 diabetes in children are major problems in many countries. These contradicting nutritional crises strongly affect the way we care for children with diabetes and their families. Recent international guidelines on the care of children with type 1 diabetes and type 2 diabetes recognize that effective nutritional management and the adoption of a healthy lifestyle can improve diabetes outcomes.

For some time now, international agencies have been warning about the rapid increases in the rates of diabetes and other chronic disease in Asian countries. Asia already accounts for a sizeable proportion of the world’s population with diabetes and the prevalence of diabetes in the region looks set to rise dramatically in the coming years. In addition, the age of onset of type 2 diabetes is moving downward. While the condition was historically diagnosed in people over age 65 years, nowadays type 2 diabetes in young adults is not unusual.

The Beverage Guidance Panel was assembled to provide guidance on the relative benefits and risks for health of various categories of drink. Initiated by the first author of this article, the Panel’s purpose was to attempt to systematically review the literature on beverages and health, and provide guidance to consumers; and to develop a deeper dialogue among the scientific community on beverage consumption patterns. The Panel aimed also to highlight the great potential of changing these as a way to improve health.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder to affect women of reproductive age. Although it was first described almost 70 years ago, there has been no universal agreement about its definition. Eleni Kousta and Stephen Franks describe the prevalence, symptoms, and cause of PCOS, and look at long-term health implications and the available and possible future treatments for women with the syndrome.

It is often stated that dietary management is a cornerstone of diabetes care. More recently, physical activity has also been recognized as a useful fundamental intervention. When it is realized that both of these can affect a variety of the problems that bedevil people with diabetes – including excess body weight, high blood glucose levels, high blood fat levels, and high blood pressure – it is not difficult to see why these issues might be regarded as fundamental.

President's Editorial

The relatively recent emergence in children of type 2 diabetes, a condition once considered ‘late-onset’, has been viewed with consternation around the world. Guidelines directed at healthcare professionals dealing with children have generally focused on type 1 diabetes; it is only now becoming apparent that type 2 diabetes in children is a serious condition and that it is at least as demanding to manage. The chapter on children in the Global Guideline seeks to raise awareness of these problems, which are faced by increasing numbers of families.