More on obesity and diabetes

Although healthcare professionals urge diabetics to participate in regular exercise – something that improves many of their risk factors – exercising is often difficult or impossible for diabetics.

Prof Stephen Rössner recently highlighted this issue at a special course for diabetes specialists at the first Regional Congress on Obesity (organised by the International Association for the Study of Obesity), held in October 2004.

According to Rössner, the following factors play a role:

• A study has shown that 50% of older diabetics had contraindications to exercise
• Only 1/3 of these individuals were able to do an hour of exercise per week
• Only 3 out of 17 patients (18%) were capable of walking 1 mile (1,6 km)
• Unrealistic demands that patients should exercise, led to frustration and a high dropout rate

It is evident that individuals with diabetes have serious problems when it comes to complying with the recommendation that they should exercise for 30 min a day. But, where there is a will, there is a way.

Diabetes and obesity in children and teenagers
One of the most frightening aspects of the worldwide obesity epidemic, is the fact that more and more children and teenagers are suffering from diabetes.

Prof Rössner identified a number of reasons why the youth of today is caught up in the spiral of obesity and diabetes, namely:

• Modern children no longer get the opportunity to play games outdoors. Problems in terms of security, working parents, living in high-rise flats and other factors make our children house-bound, which prevents them from getting regular physical activity. In South Africa this problem is compounded by the fact that the ‘new’ education system no longer includes PT (physical training) as part of the curriculum. Children don’t even get a chance to swim or do athletics for an hour a week. A representative of the government did mention that there are moves afoot to reinstate physical training at government schools in the near future to combat escalating obesity in our children.
• Modern forms of transport prevent young people from walking or cycling to school. In South Africa security concerns have fuelled the trend to transport children to and from school by ‘Mom’s taxi’ or bus.
• High-tech gadgets, so beloved by the youth, contribute to ever-increasing sloth. Cellular phones and remote controls deprive us from walking and being active. Prof Rössner calculated that by using cellular phones and remote controls, the average individual loses 146 km of walking a year and therefore, saves up to 6000 calories. This translates into 4-5 kg of additional fat that is stored in that individual’s body. Over a five-year period just the fact that we use remote controls and cell phones can cause a weight gain of 20 to 25 kg - a whopping increase!

The answer to the problem of sloth is relatively simple: stop using gadgets and start being active on a daily basis. By walking to and from work or school, and by using the stairs instead of the lift, that massive 25 kg gain over five years can be prevented.

Emotional overeating
Prof Rössner also outlined a number of psychological reasons why people overeat. These include:

• anxiety,
• anger,
• frustration,
• guilt,
• depression,
• boredom,
• feelings of failure,
• self-pity,
• joy (most people overeat at happy celebrations).

The finding that nine out of 10 obese people have a negative outlook on life and suffer from one or more of the above-mentioned emotional problems that cause them to eat more than normal, is a sobering thought.

Exploring emotions that are linked to overweight is an important and much neglected aspect of obesity and diabetes.

It is essential to get help from a clinical psychologist if you are using food as an emotional crutch. Psychotherapy could be the key to losing weight if you can identify the emotional problems that cause overeating and learn to deal with them in a positive, non-food related way.

Other factors that fuel the obesity epidemic
There are many more factors that fuel the modern obesity epidemic. Prof Rössner highlighted the following:

• Obese individuals have a problem to stop eating when they sit down to a meal. Animals stop eating when the are satiated or full, humans stop eating for a variety of other reasons, e.g. food loses it’s taste, all the available food has been eaten, other people at the table have stopped eating etc.
• Obese individuals tend to overeat at certain times of the day and night, particularly between 4 pm and midnight. So-called ‘night eaters’ have an eating peak after 10 pm, a research finding that has as yet not been explained. Unfortunately, we don’t know why some people start to eat frantically as night falls and reach a peak around 10 pm.
• Food portions at fast-food outlets are far too big. This is especially evident in the USA, the country with the highest obesity rate in the world. Some cookies and muffins in the USA are big enough to feed an entire family!
• Research has indicated that the staggering increase in the consumption of sweetened cold drinks in the USA and elsewhere, including South Africa, is contributing to the obesity epidemic. Researchers are finding that ‘liquid calories or kilojoules’ are more fattening than energy derived from solid foods. Why this is so, remains a mystery, but it is probably one aspect of dietary intake that can be addressed. By not drinking sweetened cold drinks or fruit juices, and replacing them with calorie-free drinks such as water, tea and coffee without sugar, soda water, diluted fruit juice, and cold drinks that are artificially sweetened, one can cut calorie intake to a large extent.

It is evident that life in the 21st century is designed to make us fat and cause diabetes. Our remote controls and other gadgets, cell phones, public and private transport, massive portions of fast food, oceans of cold drinks and lack of physical exercise all contribute to this growing epidemic.

Some of the solutions are deceptively simple: be more active in your everyday life, do some exercise every day, learn to stop eating when you are satiated, eat as little fast food as possible and select the smallest portions if you do, and stop drinking sweetened cold drinks.

If we don’t stop this epidemic, the entire population of the world will soon be obese and a large proportion will be diabetic. Start doing something about this problem today. – (Dr Ingrid van Heerden, DietDoc, April 2005)