Full Obesity and diabetes: a heavy burden report (Word) 144KB

Type 2 Diabetes & Obesity:A Heavy Burden

A report from Diabetes UK

The charity for people with diabetes

March 2005

Diabetes UK, 10 Parkway, London, NW1 7AAwww.diabetes.org.uk, Telephone 020 7424 1000Registered charity number: 215199

Diabetes & Obesity: A Heavy BurdenA report from Diabetes UKThe charity for people with diabetes

Contents Page

Executive summary 4

Introduction 5

Diabetes Today 6

Obesity Today 7

Diabetes & Obesity -

The links

9

Preventing Diabetes 10

Taking action, public health measures

10

Staying active & Eating Well 12

What next? 15

What is diabetes? 16

About Diabetes UK 17

References 18

Diabetes & Obesity: A Heavy Burden

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Executive Summary

Obesity is one of the biggest public health challenges facing the United Kingdom

today. Excess weight can lead to a number of debilitating conditions including Type

2 diabetes, cardiovascular disease and stroke. Obesity is a rapidly increasing

problem.

In the last 22 years obesity has nearly trebled in adult women and nearly

quadrupled in men1.

It now affects over one in five adults in the UK2

The prevalence of Type 2 diabetes has increased dramatically in the last decade,

primarily because of the link with obesity.

In the 1950’s 200,000 people were diagnosed with diabetes in the UK. The

figure in 2004 stood at 1.8 million3.

100,000 people are diagnosed with Type 2 diabetes every year in the UK4.

The more overweight you are, the higher your risk of developing Type 2 diabetes.

Over a ten year period those with a BMI of over 35 are up to 80 times more

likely to develop the condition than someone with a BMI of less than

225.

Once your BMI is over 30 you are already up to 10 times more likely to get

diabetes6.

The impact of obesity on both individuals and the NHS is enormous. Diabetes alone

can lead to serious complications such as heart disease, blindness, kidney failure,

stroke and nerve damage leading to amputation.


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Up to 75 per cent of deaths in people with Type 2 diabetes are due to

cardiovascular disease, many of these are premature7.

Diabetes is the leading cause of blindness in people of working age8.

The government published a white paper for England, ‘Choosing Health: making

healthier choices easier’ in November 2004. The paper highlighted a range of

measures to improve public health. Amongst other things, these aim to reduce the

number of people who smoke, reduce obesity, improve diet and nutrition and increase

levels of physical activity.

Obesity is a problem which must be tackled now. It needs to be addressed throughout

society. The responsibility lies with everyone, from the Government and NHS to

parents and individuals. Inaction on this issue will cost lives.

Introduction

Obesity and Type 2 diabetes are inextricably linked. In many cases obesity

contributes to Type 2 diabetes. Not only this but both conditions lead to other health

problems, both render high costs to the individual and the NHS and both are

increasing dramatically in the UK.

Obesity now affects over one in five adults in the UK. Diabetes is diagnosed in 1.8

million people and we estimate there are a further million people who have the

condition but don’t know. Together these conditions have a massive impact on the

health of the nation. In addition, the situation only seems to be getting worse.

This report will look at diabetes and obesity in detail – the scale of the problem, the

increases in prevalence and projections for the future. It will also look at how and

why the two conditions are linked and at diabetes prevention studies that have been

conducted in the past. Finally it gives practical information on lifestyle changes which

could help individuals to delay or prevent the onset of Type 2 diabetes.


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Diabetes Today

There are currently 1.8 million people in the UK with diagnosed diabetes and a

further 1 million who have the condition but are not yet aware of it. Diabetes is a

rapidly increasing problem. Type 2 diabetes is seeing the largest increase in numbers

of cases. This is driven largely by lifestyle factors including lack of physical activity

and an unhealthy diet both of which can lead to being overweight.

Risk Factors

Age

The UK has an increasingly ageing population. The 2001 Census showed almost 9.5

million people over the age of 65. This is an increase of 51 percent since 1961. A

further 18 million people are in the 40 – 64 age range. The risk of Type 2 diabetes

increases with age.

Weight

Being overweight increases the risk of Type 2 diabetes. 80 per cent of people with

Type 2 diabetes are overweight at the time of diagnosis9.

The UK has also recently seen the appearance of Type 2 diabetes in children. All the

reported cases so far have been in overweight children. Type 2 diabetes in children is

already a significant problem in the US. The public health white paper mentioned

above includes measures to tackle obesity in children. These should help to reduce

the numbers of children developing Type 2 diabetes.

Ethnicity

According to the 2001 Census minority ethnic groups now constitute nine per cent of

the population of England. Those of an African-Caribbean or Asian background are

up to six times more likely to develop diabetes.

Poverty

Diabetes, along with obesity is more common in poorer areas.


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Complications

Diabetes is a serious condition which can lead to heart disease, kidney disease,

blindness, stroke and nerve damage leading to amputation.

Obesity Today

There has been a rapid escalation in the number of people who are overweight and

obese both in the UK and worldwide. Poor diets and increasingly sedentary lifestyles

are blamed. The availability of high fat, high salt fast food, increasingly sedentary

lifestyles, wider use of household appliances to make life easier and a heavier

reliance on cars will all have had a part to play.

How is it measured?

Obesity is commonly measured according to their Body Mass Index (BMI). A

mathematical formula is used which takes into account a person’s height and weight.

BMI equals weight in kilograms divided by height in metres squared. BMI results are

usually split into categories of underweight, healthy weight, overweight, obese and

morbidly obese.

For Caucasians, a healthy weight would be a BMI of 18.5 – 24.9. Individuals with a

BMI of between 25-29.9 are considered overweight, while individuals with a BMI of

30 or over are considered obese. A BMI of over 40 is classed as morbidly obese. The

figures in each of these categories are slightly lower for people of Asian origin.

Although BMI is a useful measure, it does not take into account the difference

between excess fat and muscle, nor does it identify where the fat lies on the body. For

example, excess fat abdominally can have more serious health consequences.

Measuring waist circumference is a very practical way to assess body fat and health

risks. Abdominal fat and a high waist circumference are good predictors of increased

risk for cardiovascular disease, high blood pressure and Type 2 diabetes.


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Those at highest risk are men with a waist circumference greater than 40 inches and

women with a waist circumference greater than 35 inches. In Asian men the figure is

36 inches and in Asian women the figure is 32 inches.

How many people in the UK are affected?

Recent studies show that over two-thirds of men and nearly two-thirds of women are

either overweight or obese. Britain has the fastest growing rate of obesity in the

developed world.

Obesity now affects over one in five adults. In the last 22 years obesity has nearly

trebled in adult women and nearly quadrupled in men. Children are also affected,

obesity in 6 – 15 year olds trebled in 11 years. 16 per cent of this age group are now

obese10.

Is the situation likely to deteriorate?

Yes. If current trends continue, at least one third of adults, a fifth of boys and a third

of girls will be obese by 2020. However, if the rapid acceleration in childhood

obesity in the last decade is taken into account the figures are frightening. The

prevalence in children could be over 50 per cent by 202011.

Diabetes & Obesity - The links

We don’t yet know the exact causes of Type 2 diabetes, only that it develops because

of a mixture of genetic and environmental factors.

In Type 2 diabetes a poor diet and sedentary lifestyle are among the most important

environmental factors. This is because these factors lead to being overweight or


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obese. Being overweight is widely linked with Type 2 diabetes. Some sources

suggest that as many as 80 per cent of people with Type 2 diabetes are obese12.

Insulin resistance

In particular, being overweight is strongly associated with insulin resistance, a

condition which affects many people with Type 2 diabetes. Insulin is the hormone

that helps the body use glucose for energy. Insulin resistance occurs when the body is

unable to respond properly to insulin, preventing it from transferring glucose from the

blood to the cells. This means that the body cells can’t take up enough glucose,

resulting in rising glucose levels in the bloodstream. If these levels rise too high the

person may be diagnosed with Type 2 diabetes. Many doctors believe insulin

resistance is the main cause of Type 2 diabetes.

Increasing the risks

The risk of developing Type 2 diabetes increases progressively the heavier you are.

One study has shown that over a ten year period those with a BMI of over 35 are up to

80 times more likely to develop the condition than someone with a BMI of less than

22. Once your BMI is over 30 you’re already up to 10 times more likely to get

diabetes.

It is estimated that at least half of all diabetes cases would be eliminated if weight

gain in adults could be prevented13.

Preventing Diabetes

There are studies which indicate that the onset of Type 2 diabetes could be prevented

or significantly delayed.

The Diabetes Prevention Program, which was undertaken in America, compared the

effect of diet and physical activity to treatment with medication in 3,234 people with

impaired glucose tolerance (which indicates an increased risk of developing Type 2

diabetes). The aim was to prevent them from developing Type 2 diabetes.


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The study proved that modest changes to diet such as reducing the intake of fat,

combined with taking 30 minutes of routine exercise a day such as walking, were

effective in reducing the risk of diabetes.

A similar study in Finland also reported that diet and physical activity changes made a

significant difference to the health of the participants. The findings indicated that the

changes made prevented the development of diabetes in up to 58 per cent of people

with impaired glucose tolerance.

Taking action, public health measures

The recently published public health white paper for England sets out a number of

measures which aim to improve the general health of the nation. Northern Ireland,

Scotland and Wales also have measures in place to tackle public health. Many of

these measures should help to reduce the numbers of people developing diabetes and

should also help those already diagnosed to manage their condition.

To accompany the white paper the Government has also published a delivery strategy,

a ‘Food and Health Plan’ and a ‘Physical Activity Plan’ for England which all outline

how the policies laid out in the white paper will be turned into action.

The Department of Health in England have commissioned the National Institute of

Clinical Excellence to prepare definitive guidance on prevention, identification,

management and treatment of obesity, a report due to be published in 2007. The white

paper admits that services for treating obesity are not currently working as well as

they should.

Specific plans in the white paper include:

Developing coordinated activity on obesity prevention and management, with

each Primary Care Trust having a specialist obesity service.


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Setting up a National Partnership for Obesity, which will promote practical

action on the prevention and management of obesity. A ‘weight loss’ guide

will also be produced.

Simplifying nutritional labelling on food and making it mandatory on

packaged foods. Providing people with easy-to-read nutritional information

about the food they are buying has the potential to make a real difference to

the lives of people with diabetes.

Promotion of physical activity. A Local Exercise Action pilot programme is

currently in place and a physical activity promotion fund is to be set up.

There are also plans to come up with best practice guidelines on free

swimming and other sport initiatives.

Type 2 diabetes in children is linked with growing levels of obesity and the problem

is increasing. Some measures in the white paper are specifically aimed at improving

the health of children:

Encouraging more schools to join the National Healthy Schools Programme,

and providing investment to improve nutrition in schools.

All four to six year olds will be given a free piece of fruit or veg every day.

Investment in PE and sport.

Restriction of advertising and promotion of junk foods to children. Initially

these will be voluntary codes for the food industry. However, if changes do

not occur, then the law would be used to implement a framework for

regulation of the promotion of food to children.

The white paper outlines a whole range of measures which aim to improve the health

of the nation and which should help to slow the increasing prevalence of Type 2

diabetes in the UK.

Staying active & Eating Well

So, the Government appears to be tackling the issue but it is essential that individuals

also take action. Many people could make a significant difference to their future


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health by making lifestyle changes. Taking control, being more active, eating a

healthier diet and losing weight if you’re overweight will have benefits not just for

health but for many aspects of daily life. What are you waiting for?

Get active

Just the word exercise can be enough to put some people off. The thought of

‘pumping iron’ at the gym or going jogging in the freezing cold can seem less than

appealing. However, benefits don’t come only from what we traditionally view as

exercise. Just being more active in our daily lives will reduce the chance of

developing Type 2 diabetes and help to control blood glucose levels in those who

already have the condition. Physical activity is good for the whole body. Among

other things it lowers blood pressure, strengthens the heart, improves circulation and

improves blood fats (cholesterol and triglycerides).

Changing your habits is important if you want to increase your activity. Changes

don’t need to be drastic. For those less likely to go to the gym there are many simple

things that can be done to increase activity levels and reduce your chances of

developing diabetes. These tips will also help those who already have the condition

control their blood glucose levels.

Getting Active Top Tips

1) Take the stairs instead of the lift and walk up escalators.

2) Try and do housework or wash the car as vigorously as possible.

3) Where possible, don’t take the car on short journeys to the shops, if you

can manage it, walk and carry the bags home.

4) Regularly get off the bus a stop earlier or park your car further away from

your destination than you would usually.

5) If you have children or grandchildren suggest an active game like frisbee

or football. It shouldn’t even feel like exercise.


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If you are less mobile, you can still increase your activity - armchair exercises, gentle

walks and stretching programmes will all help to keep you as mobile and fit as

possible. If you intend to try a new activity other than walking, let your doctor or

diabetes team know so that they may reassure you that there’s no risk to your health.

You are what you eat

Everyone benefits from regular physical activity and eating a healthy, balanced diet

but the benefits for people with diabetes are even greater. If overweight, losing

weight helps to control diabetes. It is important to lose weight slowly over time rather

than by drastic dieting. Even losing a small amount and keeping it off will help.

The diet for people with diabetes is the healthy diet recommended for everyone.

Although choosing food wisely and adopting sensible eating habits can help to

manage diabetes, people with the condition can still enjoy a wide variety of foods as

part of a balanced diet.

For everyone, food should ideally be low in fat, sugar and salt, with plenty of fruit and

vegetables. Meals should include starchy foods, such as bread, potatoes, cereals,

chapatti, pasta and rice.

The following steps give advice on controlling blood glucose levels, blood fats and

blood pressure as well as regulating weight.

1) Eat regular meals including on starchy foods such as bread, pasta, chapattis,

potatoes, rice and cereals. This will help control blood glucose levels. Whenever

possible, choose wholegrain varities that are high in fibre.

2) Try and cut down on fat, particularly saturated fat as this is linked to heart

disease. Use less butter, margarine, cheese and fatty meats. Choose low fat dairy

foods like skimmed milk and low fat yogurt. Grill, steam or oven bake instead of

frying or cooking with oil or other fats.


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http://www.diabetes.org.uk/physical_activity/stretch.htm

3) Eat more fruit and vegetables — aim for at least five portions a day to provide

vitamins, minerals and fibre as well as to help balance the overall diet.

4) Cut down on sugar and sugary foods — this does not mean you need to eat a

totally sugar-free diet. Choose diet, low sugar or sugar free squashes and fizzy drinks

as sugary drinks can cause blood glucose levels to rise quickly.

5) Use less salt, because having too much can raise blood pressure. Try flavouring

food with herbs and spices instead of salt. As most of the salt we eat comes from

processed food try to make your diet as ‘fresh’ as possible.

6) Drink alcohol in moderation only, that’s two units a day for women and three

units a day for men.

7) Don't be tempted by ‘diabetic’ foods or drinks. They are expensive, unnecessary

and have no added benefit for people with diabetes.

What next?

Current predictions for the future prevalence of both obesity and diabetes indicate

there will continue to be a steep increase in both. Rates of diabetes complications -

1 Storing up problems, The medical case for a slimmer nation. Report of a working party. Royal College of Physicians, Royal College of Paediatrics & Child Health, Faculty of Public Health. 2004.2 As above. 3 Diabetes. G.F.Walker. 19554 Moving up with diabetes, Datta, J. 2003, National Children’s Bureau. 5 Handbook of Diabetes. Gareth Williams, John C. Pickup. Blackwell Publishing, 2004.6 Diabetes Contemporary Issues Companion. Louise I Gerdes. 2003. T Greenhaven Press.7 Ross, S. & Gadsby, R. Diabetes and related disorders. 2004 Mosby: London.8 Report of the Visual Handicap Group, Kohner et al 1996, Diabetic Medicine, 13, Supplement 4, S13-S269 Redefining Type 2: diabesity or obesity dependent diabetes mellitus. Astrup & Finer, 2000, Obesity Review. 1 57-9. 10 Storing up problems, The medical case for a slimmer nation. Report of a working party. Royal College of Physicians, Royal College of Paediatrics & Child Health, Faculty of Public Health. 2004.11 See reference 9.12 Handbook of Diabetes. Gareth Williams, John C. Pickup. Blackwell Publishing, 2004.13 Diabetes & Obesity, Time to Act. The International diabetes Federation, 2004.


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for example heart disease, stroke and blindness - will increase correspondingly.

It is essential that action is taken to reduce the health risks for future generations. The

Government must ensure that the measures set out in the public health white paper are

effective in addressing obesity. The health service have a key role to play, ensuring

that people with weight problems are supported to lose weight by making lifestyle

changes. It is also crucial that individuals and families accept responsibility for their

own health and take action to reduce their risk of diabetes and other weight related

health problems.

If nothing is done to tackle these issues now the impact on the future health of our

children will be immense. Even steeper increases in obesity, diabetes and its

complications would mean a bleak outlook for public health. Every individual has the

opportunity to make a difference to these prospects and action must be taken now.


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What is diabetes?

Diabetes mellitus is a common condition in which the amount of glucose (sugar) in

the blood is too high because the body cannot use it properly. Glucose comes from the

digestion of starchy foods such as bread, rice, potatoes, chapattis, yams and plantain,

from sugar and other sweet foods, and from the liver, which makes glucose.

Insulin is vital for life. It is a hormone produced by the pancreas that helps the glucose

to enter the cells where it is used as fuel by the body.

The main symptoms of diabetes are increased thirst, going to the loo all the time -

especially at night, extreme tiredness, weight loss, genital itching and/or regular

episodes of thrush, and blurred vision.

Type 1 diabetes develops if the body is unable to produce any insulin. This type of

diabetes usually appears before the age of 40 and especially in childhood, however, it

can develop at any age. It is treated by insulin injections and diet, and regular physical

activity is recommended.

Type 2 diabetes develops when the body can still make some insulin, but not enough

for the body’s needs, or when the insulin that is produced does not work properly

(known as insulin resistance). This type of diabetes usually appears in people over the

age of 40 and the older you are, the greater your risk of Type 2 diabetes. If you come

from a black or minority ethnic group, are you are increased risk over the age of 25.

Type 2 diabetes is treated by diet and physical activity, or by diet, physical activity

and tablets, or by diet, physical activity and insulin injections.

The main aim of treatment of both types of diabetes is to achieve near normal blood

glucose and blood pressure levels. This, together with a healthy lifestyle, will help to

improve wellbeing and protect against long-term damage to the eyes, kidneys, nerves,

heart and major arteries.


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About Diabetes UK

Diabetes UK is the charity for people with diabetes. We stand up for the interests of

people with diabetes by campaigning for better standards of care. We also fund

research to improve the treatment of diabetes and to find a cure, and we provide

practical information and support services to help people manage their diabetes better.

We have over 180,000 members and a network of offices across the UK. We are one

of the largest patient organisations in Europe.

Diabetes UK works for people with diabetes, their carers, family and friends. We

represent the interests of people with diabetes by lobbying the government for better

standards of care and the best quality of life. Diabetes UK spends over £4.5 million on

research every year to improve the treatment of diabetes and we hope our research

will ultimately lead to finding a cure for diabetes.

Diabetes UK’s mission is ‘to improve the lives of people with diabetes and to work

towards a future without diabetes’.

Specifically we want to:

set people free from the restrictions of diabetes

ensure the highest quality care and information for all

end discrimination and ignorance

ensure universal understanding of diabetes and Diabetes UK

achieve a world without diabetes.

Further information

For more information about Diabetes UK visit our website at www.diabetes.org.uk

or phone us on 020 7424 1000.


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References


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