Scales tipping toward diabetes: Twin scourge of weight and disease could 'break the bank' of health care
Nov. 23, 2002

By Nanci Hellmich and Anita Manning
USA TODAY

If Americans keep putting on the pounds at the current rate, almost everyone is going to be overweight by 2030, a top obesity researcher says.

And this probably will lead to a skyrocketing number of people who develop diabetes, a disease that can have catastrophic health consequences, including heart attacks, strokes, blindness, kidney disease and amputations, experts say. Ultimately, treating the disease and its complications could bankrupt the health care system, they warn.

“I think everyone is going to get fat,” says weight-loss researcher John Foreyt of the Baylor College of Medicine in Houston. “The obesity epidemic is going to continue. I believe that. I’m not just talking to be an alarmist. And it’s not just cosmetic; it’s a serious problem.”

These grim projections from some of the nation’s top obesity and diabetes doctors are based on new government statistics showing that almost 65 percent of American adults, or more than 120 million people, are overweight or obese.

About 31 percent of adults older than 20 are obese, defined as roughly 30 pounds or more over healthy body weight, and 34 percent are overweight, which is about 10 to 30 pounds above a healthy weight.

Foreyt predicted in a 1995 scientific journal article that almost everyone in the United States would be overweight or obese by 2230. Now he has moved that up 200 years. At the rate we’re going, he says, almost everyone could be not just overweight, but obese, by 2100.

In reality, Foreyt and others say, we won’t reach a point at which every single American will weigh too much. Some small percentage, possibly 5 percent to 15 percent, probably will be able to maintain a healthy weight because they are genetically protected, or they are willing to carefully watch what they eat and be fairly active. But they will be part of an ever-increasing minority, Foreyt says.

That’s a serious problem not only for Americans’ health, which will be at growing risk for diabetes, heart disease, liver disease, cancer and other health problems, but also for the health care system. Some experts predict it could buckle under the weight of these obesity-related complications.

Of greatest concern is diabetes, “the most prevalent, serious medical complication of being overweight and obese,” says Samuel Klein, president of the North American Association for the Study of Obesity (NAASO).

Reflecting scientific concern over the confluence of diabetes and obesity, the American Diabetes Association is collaborating with NAASO at the obesity researchers’ annual meeting next fall.

Diabetes is a condition in which the body does not make enough of the hormone insulin, or it doesn’t use the insulin properly. Insulin helps sugar get into cells, where it is used for energy. If not enough insulin is produced or if insulin does not function normally, sugar builds up in the blood, damaging nerves and blood vessels.

“There’s an incredibly strong link between obesity and diabetes, linked to the inability of the body to make use of sugars normally,” says pediatric endocrinologist Francine Kaufman, president of the American Diabetes Association. As weight increases, the body produces extra insulin, but “there gets to be a point, and we don’t understand why,” at which the body’s need for insulin surpasses its ability to produce it, she says.

Type 2 diabetes is the most common form, affecting up to 95 percent of the more than 17 million Americans who have the disease. Unlike type 1, or juvenile, diabetes, which is caused by destruction of insulin-producing cells in the pancreas, type 2 is associated with a combination of genetics, excess weight and a lack of exercise. Those result in a cascade of physical changes leading to the disease.

Cost of obesity: $123B in 2001

Experts say the United States and other countries simply can’t afford to deal with the problem. Obesity cost the United States about $123 billion in 2001, including direct health care costs for diseases related to obesity and indirect costs such as loss of productivity, according to an analysis by Anne Wolf of the University of Virginia.

“We calculated that 61 percent of diabetes is attributed to obesity,” Wolf says. The direct cost of obesity is about 30 percent higher than coronary heart disease, she says.

“Diabetes is going to be the way this obesity epidemic breaks the bank,” says James Hill, director of the Center for Human Nutrition at the University of Colorado Health Sciences Center in Denver.

Foreyt agrees. “We’re just not prepared from a health care point of view to handle the type 2 diabetes we’re going to see in the next few years.”

‘A problem of our children’

Type 2 diabetes is on the rise in all age groups. Until about 20 years ago, it almost never occurred in teens or children, but doctors say almost half the new cases of diabetes diagnosed in kids are type 2.

Because an estimated 20 percent to 30 percent of American children are either overweight or at risk of becoming so, the rates of diabetes in teens and young adults in just a few years could be staggering, experts say.

“What used to be a disease of our parents and grandparents is now a problem of our children,” Kaufman says.

The costs will be felt not only by individuals and families, but also by society as a whole, she says. “This could impact on the workforce in the next generation.”

Hill and colleagues are treating children as young as 11 with the disease.

“We are seeing a lot of type 2 diabetes in overweight children, and these are just the ones that come in. The speculation is that there are a bunch of overweight kids who have it, but who don’t know they have it,” Hill says. “This is new to our medical system to be treating this in children. We have no idea what a 12-year-old with this disease will look like at 40 or 50, or even if they’ll make it to 50.”

Experts believe genetics plays a key role in who develops diabetes. Some people will never become diabetic even though they are very fat, but others have a genetic predisposition and might develop it even if they are just a few pounds overweight, says Xavier Pi-Sunyer, chief of endocrinology at St. Luke’s-Roosevelt Hospital in New York.

That genetic liability is highest in certain ethnic groups, such as Native Americans, Mexican-Americans and other Hispanics, he says. For example, he says, about 70 percent of Pima Indians are overweight, and about 50 percent are diabetic.

Once a person has diabetes, it can lead to a host of other health care issues, especially if it is not controlled.

“The biggest problem with diabetic patients is they have a higher rate of heart disease,” Pi-Sunyer says. “They are more likely to die of heart attacks and strokes.”

Yet studies show that by keeping blood pressure, cholesterol and blood-sugar levels under control, people with diabetes can reduce the risk of complications. For every 1 percent reduction in blood-sugar levels, there is a 40 percent reduction in risk for eye, kidney and nerve diseases; for every 10-point reduction in systolic blood pressure (the top number), the risk of any complication from diabetes is reduced 12 percent; improving cholesterol and triglycerides reduces cardiovascular complications by 20 percent to 50 percent.

Stop obesity, stymie diabetes

“One thing we really have to do in this country is to start treating obesity as an illness,” says Matt Petersen of the American Diabetes Association. “We know the primary risk factor for type 2 diabetes is obesity. If we can stop people from getting obese, we could prevent a significant amount of type 2 diabetes.”

Research shows that if patients at high risk for developing diabetes make lifestyle changes - exercise regularly and lose 5 percent to 7 percent of their weight - they can decrease their chance of progressing to diabetes by 58 percent.

Type 2 diabetes is very sensitive to weight loss, says Wolf of the University of Virginia. When diabetics lose a few pounds, it can improve glucose control, she says.

“It is so amazing to see that a small weight loss can improve health and quality of life and get these people off some of their medications,” Wolf says. “We’re seeing reductions in health care costs, and the study patients feel so good about themselves.”