A disparate burden  pg. 3

Having become a diabetes expert out of necessity, Reid knows that the tighter he controls his blood sugar – through watching what he eats and keeping active, as well as through judicious insulin supplementation – the more likely it is he will avoid health complications down the road.
Photo by Anne Rayner
It is this modern Western lifestyle of too much food and too little exercise that many are concluding is behind the explosion of type 2 diabetes in this country. While genes may set us up for diabetes, it appears to be behavior that tips the scale.

And tipping the scales is literally what we’re doing, from all evidence. Obesity among adults has doubled since 1980, while overweight among adolescents has tripled, according to former U.S. Surgeon General David Satcher’s 2001 report Call to Action. Especially at peril are children, where obesity and type 2 diabetes—formerly known as “adult-onset”—are increasing hand-in-hand at an alarming pace, leaving them vulnerable for years to come.

So is it genetics or is it environment at the heart of the epidemic? And why are certain people at particular risk for what Dr. James R. Gavin III, former president of Morehouse School of Medicine in Atlanta, Ga., and past chair of the National Diabetes Education Program, calls “diabesity”?

One of the most enduring theories as to why so many humans are poorly suited for our modern lifestyle, is a notion first posed three decades ago by genetics pioneer Dr. James V. Neel, that of the so-called “thrifty genes.”

Neel proposed that certain genes allowed ancestral hunter-gatherers to store fat during times of feast to survive times of famine. Today, with our easy access to caloric abundance, those genes that were designed to protect us from starvation are now a major handicap.

The anatomy of change

Some experts say it is this heritable penchant for high-energy foods that makes diabetes so hard to beat. The current wisdom for diabetes prevention and control -- weight loss through sensible diet and moderate exercise—is good advice for anyone. Making those changes, however, can be difficult for many people.

Fast food is everywhere, it’s cheap, and it tastes good. And when money is tight, it’s hard to argue when a hungry family can be satisfied for just a few dollars.

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