New and interesting questions were presented this week during my diabetes teaching sessions and I would like to share them with you. You may have read these stories in the recent headlines but let’s review them as I did in practice with my patients.
- I read that obesity is now considered its own illness. What does that mean?
Obesity has finally been recognized as an illness by the AMA (American Medical Association). Other national medical organizations including The Endocrine Society, The AACE (American Association of Endocrinologists) and the American College of Cardiology were completely on board as endorsing obesity as a disease. This is a huge public health improvement since reimbursement for education, treatment and prevention should finally be covered by insurance programs. Obesity is identified as a “multi-metabolic and hormonal disease state which includes certain signs and symptoms which increases the risk of death.” This helps define it as a disease. For years it was only considered a “symptom” of a disease. Obesity actually increases the risk of cardiovascular disease, type 2 diabetes, breast/colon cancer, hypertension, hyperlipidemia, sleep apnea, gout and gall bladder disease. Obesity is generally determined by a BMI (body mass index) of 30kg/m. Although BMI is not a perfect measure it is the one that is presently used. Adult obesity (over 20 years of age) cost the United States between 147-210 billion dollars in health costs as well as lost time in the work place per year. It can shorten a life span by 7 years and severe obesity (BMI above 40kg/m) can shorten a life by 10 years. Hispanics and African Americans have the highest percentage of obesity but it does affect all ethnicities. It is quickly becoming a world wide epidemic even in remote areas. The current change in disease classification will help to create a medical model to address treatment, prevention, lifestyle modification, medications, surgery, and public education as well as behavioral change/talk therapy to treat obesity. Be aware of changes and see which services may be available to help you.
- A gentleman in his 40s presented this week for diabetes education; he was completely confused because he was diagnosed with type 2 diabetes although he is at his ideal body weight. He assumed that “only over weight people got type 2 diabetes” and asked can skinny people really get type 2 diabetes too?
Although 80% of people with type 2 diabetes are over weight there are still 20% who are not. There are a percentage of obese people who are considered metabolically healthy with normal blood sugars and perfect insulin sensitivity. They will rarely develop diabetes. On the other extent your health care provider may overlook thin people and their need for diabetes screening. Research now shows that type 2 diabetes is more involved than just being a disease of sedentary lifestyle and an overweight body. A thin person may look that way on the outside but have a large amount of visceral fat (fat surrounding and entwined in organs) on the inside. Visceral fat often leads to insulin resistance which then proceeds to type 2 diabetes. Although very little is written in the scientific literature about thin people and type 2 diabetes; there are multiple explanations. Certainly genetics is the leading cause with an inherited defect which can cause a build up of fat inside muscle cells and create insulin resistance. One parent with diabetes type 2 increases your risk by 35 % and both parents can lead to a 75% increase whether you are thin or not. Eating habits even in thin people can also increase the risk. Consuming high fructose corn syrup in most processed foods can alter gut microbes. Eating too much sugar or using specific oils including corn, sunflower and sunflower oil can lead to insulin resistance. The liver changes fructose to fat and fat increases insulin resistance. (Similar to how the liver handles alcohol.) High alcohol intake raises triglycerides and increases insulin resistance if you are thin or not. This can lead to high blood pressure, low HDLs and more insulin resistance along with type 2 diabetes. Having extremely low Vitamin D levels or PCBs (chemicals) from farmed fish can raise insulin resistance which usually leads to type 2 diabetes. Stress raises cortisol levels- your fight or flight hormone was only supposed to be elevated during a crisis. In today’s world many of us are under constant stress which keeps high levels of cortisol circulating; this can lead to insulin resistance. Fatty liver disease called NAFLD (non alcoholic fatty liver disease) can also lead to insulin resistance. General systemic inflammation in the arteries and untreated hypothyroidism can lead to insulin resistance and eventual diabetes. Air pollution is known to cause systemic inflammation which can lead to insulin resistance. Learning all this helped him understand why he developed diabetes type 2 even at an ideal body weight. Teaching him how to care for himself became more important. We discussed starting an exercise program- aerobics and weights, monitoring carbohydrates, eating on a schedule, not smoking, getting a foot, eye and mouth exam, keeping feet covered at all times, using a glucose meter to obtain blood sugar trends, and taking medication correctly (if necessary) were still the accepted treatment for diabetes type 2 control whether thin or not!
Nothing holds true in medicine 100% of the time but being aware of why it might happen is a step in the right direction. Take control of your health no matter what size you are! Stay healthy!
NOTE: Consult your doctor first to make sure my recommendations fit your special health needs.
She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.
She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.