Lifestyle interventions

If the growing burden of obesity-driven type 2 diabetes is to be stabilized or reduced, the general public must receive adequate information about healthy eating. However, non-compliance with nutrition advice continues to hamper diabetes care. When it is available, this advice is traditionally given in standardized 24-hour menus as a list of ‘don’ts’. People are asked to keep a running count of the carbohydrates or calories they consume throughout the day. It is therefore not surprising that nutrition advice is perceived by many as being difficult to follow;

In both human and economic terms, diabetes is becoming one of the most serious and costly health conditions worldwide. Economic development, bringing changes from a traditional to a modernized lifestyle, is driving a huge increase in the number of people with obesity-related type 2 diabetes in China. The extraordinary size of the problem is worrying; if current trends continue, diabetes will become a massive health burden in China. In this article, Changyu Pan looks at the status of diabetes care in China and highlights the need for regional and national initiatives to

“For forty-eight hours after admission to the hospital the patient is kept on an ordinary diet, to determine the severity of his diabetes. Then he is starved, and no food allowed save whiskey and black coffee. The whiskey is given in the coffee: 1 ounce of whiskey every two hours, from 7am until 7pm. The whiskey is not an essential part of treatment; it merely furnishes a few calories and keeps the patient more comfortable while he is being starved.” Starvation (Allen) Treatment of Diabetes (1915).

Populations worldwide are becoming more corpulent. The levels of overweight and obesity in many low- to middle-income countries such as Mexico, Egypt, and South Africa rival that of the country used as the benchmark for this problem, the USA. Moreover, the rates of increase in obesity in these countries are double to quadruple those in the USA. In this article, Barry Popkin reports on the impact of important shifts in nutritional patterns and the trend towards inactivity.

The establishment of a practice which puts the person at the centre of care will require a change in the attitudes and beliefs of health professionals, and people with diabetes. A service which places the person with diabetes at the centre of care will undoubtedly demand the adoption of this philosophy by the organizations responsible for the delivery of diabetes care, as well as those networks serving the

World Diabetes Day 2000 focused on “Diabetes and Lifestyle in the New Millennium”. It was an occasion to (re)discover the benefits of a healthy lifestyle and the ways in which to lead such a lifestyle. The impact of lifestyle on diabetes cannot be under-estimated and the theme in 2000 was the occasion to re-address this issue.

The Middle East comprises countries such as Egypt, Israel, Jordan, Lebanon, the Palestinian Autonomous Territories and Syria, and contains several ethnic and religious groups. Moslem Arabs, however, are, by far, the largest population group and they form the dominant culture. Certain values belonging to this culture serve to make acceptance of diabetes nutritional therapy difficult. Nevertheless, it cannot be ignored that people with diabetes in the Middle East have to survive and try to be an accepted part of the society in which they live.

People with obesity have been illustrated by artists throughout our modern cultural history. Who would not recognize the clearly overweight Milon Venus or obese women in paintings by Rubens? These people, however, were rather rare exceptions during times when labour required physical work and food shortage was much more common than in the present. Although we lack specific data, it is likely that the industrial revolution together with improved food hygiene were associated with an increase in the prevalence of obesity at least among those whose labour was physically less demanding.

President's editorial

Increasing the knowledge of people with diabetes gives them motivation and promotes better diabetes control. This, in turn, enhances quality of life and delays, if not totally prevents, the onset of complications. The Danish Diabetes Education Centre, opened in Odense, 1993, does just that, by providing teaching and assistance to people with diabetes and their friends and families. The centre educates over 500 people in total each year.