It is refreshing to live in Ukraine, where I don’t have to regularly see obese children and, as a doctor, try and talk about this difficult subject with their mothers. This exercise in communication normally leaves all parties unhappy.
The growth in obesity in both adults and children in America and Western Europe, indeed, in nearly all affluent countries, has been huge and quite apparent. It is, for example, now estimated that some 30 percent of adult Americans, some 10 percent of infants and toddlers, and some 18 percent teenage children are obese. If you are 183 centimeters tall (6-feet), you should weigh no more than 83 kg (183 lbs). If you weigh up to 100 kilograms, 220 pounds, you are overweight; over that, obese.
Diabetes patients are giving blood for a quick test to determine the level of blood sugar on World Diabetes Day on Nov. 14, 2008. (UNIAN)
The growth in obesity has also been mirrored by a growth in diabetes. It is not unusual to see what we call maturity onset diabetics at the age of 35, whereas some 30 years ago the age of onset was more often at 60. The United Kingdom has a 7 percent annual increase in the number of diabetics, now some 4 percent of the adult population. Diabetes is a serious disease requiring expensive drug control and carrying increased risks for heart disease, kidney disease and others.
Not only does obesity cause diabetes, but also excess wear on our joints and spine and, for many, a loss of attractiveness, self esteem and subsequent depression.For Ukraine, the financial onus of an increase in the diabetic population would put severe strains on the already precarious health care system. The United States spends $116 billion to treat and prevent diabetes and its complications each year (some $375 per person) and that will increase 30 percent or so by 2025. Ukraine spends just $145 for each person with diabetes, or an estimated $500 million from its budget.
Ukraine is at risk from an increased growth of obesity and diabetes for several reasons. Firstly there has been a huge growth in the availability and consumption of refined carbohydrate products. This has been evident right across the country, not just in Kyiv. Ukrainians have moved away from a diet which was traditionally heavy in unrefined carbohydrates such as rough ground wheat, buckwheat, potatoes and root vegetables to one richer in refined carbohydrates and sugars.
Paradoxically, the move away from fatty food has often caused people to get energy through refined carbohydrates, driving an increased risk of obesity and diabetes and, in turn, increasing the risk of heart disease. It is interesting to perceive that Ukraine already has a prevalence of adult diabetes of 7.6 percent, considerably more than the United Kingdom, despite its less elderly population. Another factor in Ukraine is the move towards a more sedentary lifestyle, for adults and children.
We have a finite amount of the hormone insulin in our systems. The amount is probably genetically determined. We know that Indians, for example, have a high incidence of diabetes, as do their genetic peers in the Middle East. Diabetes also strongly runs in families. The amount of insulin we have is decreased in proportion to the amount of carbohydrates and sugars we consume. Furthermore, high intakes of sugars can cause insulin resistance, a process where the insulin we have doesn’t work so well and which drives both diabetes and obesity.
Diabetes is an extremely preventable disease. Government can discourage the intake of refined carbohydrates by food warnings, advertising and, ultimately, by taxation – sugar being, in effect, as dangerous as both cigarettes and alcohol. It can also foster educational programs in school about healthy diet. Individuals and parents are mostly responsible for preventing obesity and diabetes. They should keep their weight within normal limits and exercise daily. Parents should discourage the consumption of sweet foods and drinks for children, especially as it appears that sugar is quite addictive. Individuals should have a sense of their correct weight and decrease their food intake to maintain it, if they are overweight. Those with a low risk of cardiovascular disease should rely more on a balanced diet, using unsaturated fat and non-refined carbohydrates as an energy source, while more reliance should be placed upon traditional and unrefined carbohydrates.
Ukraine’s current prevalence of diabetes and the expectation that it will radically increase should be causes for concern. The almost total avoidance of sugar, cakes, biscuits and sugar containing foods and a regime of some daily exercise is tough medicine. But it brings with it considerable gains in terms of raised self esteem, physical fitness, less wear on our joints and spines, as well as the knowledge that we will successfully avoid diabetes with all its complications and medications.
Dr. Richard Styles is a British family physician at American Medical Centers, a full-service clinic, in Kyiv.
