Preventing obesity and diabetes: social remedies and lifestyle trials
Obesity and type 2 diabetes can be prevented at two levels: by changing the surroundings in which people eat and move, and by changing what each person eats and how much they move. Trials in people at high risk of diabetes have measured how far lifestyle change reduces its incidence.
How far diet and exercise prevent the two diseases
Obesity and type 2 diabetes are both largely preventable through diet and physical exercise. Obesity can be easily prevented by changes in diet and lifestyle, so targeting obesity is a logical strategy for controlling diabetes. Even modest reductions in weight and increases in physical activity can significantly reduce the risk of developing diabetes. One diabetes specialist holds that the solution to the epidemic of obesity and diabetes is to find ways to make lifestyle mimic that of Paleolithic humans, with more physical activity and fewer calories, at least until human genes adapt to the current environment.
Personal responsibility and the surroundings
Personal responsibility for preventing obesity and the onset of type 2 diabetes varies with genetics, epigenetic modifications, socioeconomic background, age, culture, education, geographic location and environmental influences. Change should start with each person's responsibility to eat less and exercise more, and each person should change the culture of their immediate surroundings, to make obesity and diabetes the next anti-tobacco campaign. The epidemic of obesity and diabetes could be halted if healthy habits are carried into local schools, workplaces and homes. Each person is responsible for creating an environment that socially stigmatises practices that lead to obesity, such as by discouraging brownies at a work meeting. One diabetes specialist holds that a tipping point has been reached at which the goal of consuming the most calories while expending the least energy is a thing of the past, and encourages each person to reframe how human progress is defined and to consider what role they will take in influencing change.
Social marketing for a new normal
Social marketing campaigns to establish a "new normal", a hypothetical state in which unhealthy eating and inactivity become socially unacceptable, are modelled on the campaigns that made smoking socially unacceptable.
Campaigns in schools
A campaign in Los Angeles County sought to ban junk food and soda from school vending machines, and similar bans have been planned or implemented in San Antonio and Hong Kong and statewide in Oklahoma and Arizona. The second thrust of the social marketing campaigns is increasing exercise. The Chicago police department sponsors a "Walking School Bus" programme in which volunteer parents accompany small groups of students walking to and from school. School efforts can be reinforced at home by programmes such as "National TV Turn Off Week", which encourages substituting exercise for television and computer games for a week each spring. The California Adolescent Nutrition and Fitness program sponsors workshops that train local activists to encourage the Hip Hop generation to embrace exercise.
The Alliance for a Healthier Generation provided schools with standards for nutrition, wellness programmes and exercise, and suggested changing the food available to students to help them make healthier choices. Changes implemented through the programme led to a 41% reduction in the total beverage calories shipped to schools in 2006–2007 compared with 2004.
Campaigns for adults and policy changes
Similar campaigns work for adults. Children's Hospital Los Angeles banned junk food, and the Centers for Disease Control and Prevention painted, carpeted and decorated stairwells with artwork, piped in music and posted motivational signs, at a total cost of $16,000, to encourage employees to add activity to their workdays. By 2005, Medicare policy had changed to make obesity treatment eligible for reimbursement even for otherwise healthy individuals, and tax law allowed fees for doctor-prescribed weight-loss programmes to be deducted as medical expenses.
Access to places to put lifestyle change into practice
The new normal is a laudable goal but not an easy one to achieve. In the Los Angeles area, for example, 25% of parents with children under age 5 did not have access to a safe park or playground. Recognising this need, Children's Hospital Los Angeles and local partners developed an online map listing local recreation programmes and farmers' markets to help diabetic patients put recommended lifestyle changes into practice.
The role of medical communicators
The role of medical communicators has become increasingly important because many people underestimate the risks of unhealthy behaviour and would rather take a pill than adjust their lifestyle. It is essential for medical communicators to provide information in ways that will influence both the public and policymakers to implement changes towards healthier lifestyles. Medical writers can promote lifestyle change by learning from what happened with smoking and making lifestyle an issue. Increased public awareness played a huge role in reducing the smoking rate from 55% of the population to 20% in the 45 years to 2007. Innovative anti-obesity programmes deserve to be publicised by medical writers who are journalists and copied by those who are parents concerned about the health of children in their communities.
Lifestyle intervention trials
A National Institutes of Health study attempted to prevent diabetes in people with impaired glucose tolerance, now referred to as prediabetes, by comparing intensive lifestyle interventions with preventive treatment with metformin, a drug normally used to treat diabetes, and with placebo. The goal was for participants to lose and maintain at least 7% of their body weight and to get at least 150 minutes of physical activity a week, mostly by walking. Walking turned out to be more effective than metformin or placebo. Although the weight loss was modest, on average 7 to 8 pounds over 4 years, lifestyle changes alone produced a 58% decrease in the incidence of diabetes. Expressed as a number needed to treat, 7 patients treated with lifestyle changes could prevent 1 case of diabetes.
In people at high risk of diabetes, the Diabetes Prevention Program Research Group found that lifestyle changes and metformin both reduced the incidence of diabetes, but lifestyle changes were far more effective than metformin alone, with reductions of 58% and 31% respectively.
The Finnish Diabetes Prevention Study suggested that lifestyle intervention can reduce the incidence of diabetes. In the study, controlling body weight, increasing physical activity and reducing the amount of fat consumed reduced the relative risk of type 2 diabetes by 43%.