June 20, 2018
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A new epidemic of ‘diabesity’ strikes adults and children alike

Michelle Pelletier | BDN
Michelle Pelletier | BDN
By Tom Walsh, BDN Staff

Obesity and type 2 diabetes, two potentially debilitating conditions, are fueling a new one-plus-one-equals-three epidemic of what some clinicians and medical researchers have termed “diabesity.”

“It’s a term that emphasizes the fact that type 2 diabetes is often associated with obesity,” said Professor Juergen Naggert, who has spent years researching the genetic components of both diseases at The Jackson Laboratory in Bar Harbor. “It requires that you have mutations of both obesity genes and diabetes susceptibility genes.”

“That’s not a term I’ve heard, but it certainly fits what type 2 diabetes is all about,” said Dr. Jonathan Fanburg, a pediatrician and adolescent medicine specialist at Maine Medical Center’s pediatric clinic in South Portland.

U.S. Centers for Disease Control and Prevention statistics show that while only 7 percent of obese people will develop type 2 diabetes, about 90 percent of those with type 2 diabetes are obese. Of particular concern to public health officials is the growing number of overweight children and adolescents who are being diagnosed with what was, until recently, termed “adult-onset” diabetes.

“In Maine we’ve recently seen some leveling off with childhood obesity, but it’s still a problem,” Fanburg said. “And type 2 diabetes is definitely a problem. A lot of things drive it: the environment, genetics and the culture that kids experience.”

While the CDC doesn’t have state or national data on the prevalence of type 2 diabetes in children, it estimates that 210,000 diabetics are under age 20 and that many thousands more are diabetic but haven’t been diagnosed.

There are two forms of diabetes, both related to the body’s ability to generate and process insulin, a hormone produced in the pancreas that regulates how cells in the body convert blood sugar into energy.

Type 1 diabetes is an autoimmune disease in which the body destroys insulin production by the pancreas, requiring daily insulin injections. Type 2 diabetes accounts for about 95 percent of all diabetes. For reasons largely unknown, type 2 diabetics are unable to effectively use the insulin their bodies produce.

Diabetes is the seventh leading cause of death in America, a ranking that many clinicians feel is understated. Insulin resistance puts type 2 diabetics at greater risk for heart disease, high blood pressure, stroke, kidney disease, nerve damage, amputations and blindness.

Underlying much of the increase in type 2 diabetes, the CDC says, is the grim reality that Americans are fat and getting fatter. Two out of three adults in America are overweight or obese, based on body mass index measurements. So are one in three children and adolescents, as the incidence of childhood obesity has more than tripled in the last 30 years.

Among high school students in Maine, 12 percent were overweight in 2011.

Fanburg said he has witnessed a “change in Maine’s culture” that makes him optimistic that fewer of the state’s children and teens will have to cope with type 2 diabetes and other medical issues related to obesity.

“What’s really helped is the success of the simple messaging of ‘5-2-1-0.’ About any kid I might encounter can tell me what that means.”

The “5” stands for five daily servings of fruits and vegetables, he said, and the “2” for limiting TV and other “screen time” to two hours a day. The “1” encourages at least one hour or more of physical activity a day, while the “0” reminds kids to not consume any sugar-laced drinks and to drink more water and low-fat milk every day.

Dr. Dora Anne Mills, a pediatrician who between 1996 and 2011 was the director of the Maine Center for Disease Control and Prevention, said interventions such as 5-2-1-0 are helping to build public awareness of obesity and sedentary lifestyles as contributors to disease and disability.

“It’s taken decades for the United States and Maine to build obesity into the fabric of our society,” said Mills, now the director of public health programs and vice-president of clinical affairs at the University of New England in Portland. “And I suspect it will take decades to build health into the fabric of our society. We have a long, long way to go.”

Do you have diabesity?

If you answer yes to any of these questions, you may already have diabesity or are headed in that direction.

  • Do you have a family history of diabetes, heart disease or obesity?
  • Are you of nonwhite ancestry (African, Asian, Native American, Pacific Islander, Hispanic, Indian, Middle Eastern)?
  • Are you overweight (BMI or body mass index over 25)?
  • Do you have extra belly fat? (Is your waist circumference greater than 35 inches for women or greater than 40 inches for men?)
  • Do you have sugar and refined carbohydrate cravings?
  • Do you have trouble losing weight on a low-fat diet?
  • Has your doctor told you your blood sugar is a little high or have you actually been diagnosed with insulin resistance or pre-diabetes?
  • Do you have high levels of triglycerides or low HDL (good) cholesterol?
  • Do you have heart disease?
  • Do you have high blood pressure?
  • Are you inactive (less than 30 minutes of exercise four times a week)?
  • Have you had gestational diabetes or polycystic ovarian syndrome?
  • Do you suffer from infertility, low sex drive, or sexual dysfunction?

Source: Dr. Mark Hyman, author of “The Blood Sugar Solution”

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