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A true “diabetes prevention program” would replace the disease economy with fitness culture.
Below is our comment on the Medicare expansion of the Diabetes Prevention Program. It is also published in the US federal government’s website here. Image may be NSFW.
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September 8, 2017
Diabetes, heart disease, cancer, and other chronic diseases kill nearly 1.9 million Americans yearly[i]. Each one of those deaths is a preventable tragedy, resulting largely from repeated lifestyle decisions imbedded in a culture corrupted by the soda and junk food industries.
The chronic disease epidemic is both the simplest and most pressing health problem facing our country today. Unfortunately, food and beverage companies and their proxies have done everything in their power to deliberately confuse and mislead the American people, policymakers, and even medical professionals regarding the causes of chronic disease[ii]. These organizations, many claiming to advocate for our health and wellbeing, have tried to shift the focus to obesity, rather than chronic diseases such as type-2 diabetes; to “energy balance,” rather than sugary drinks and junk food; and to physical inactivity, rather than nutrition. Their intention is to distract Americans from the simple fact that sugar is unhealthy.
Industry apologists present chronic disease as the result of obesity. They concede that added sugar is linked to chronic disease, but portray this effect as mediated through energy imbalance and weight gain. Yet millions suffer from chronic disease without becoming obese or even overweight[iii]. Sugar consumption, including soda drinking, can kill you even if you never get fat. High blood sugar is a major health risk whether you’re over-, under-, or normal weight.
The Medicare Diabetes Prevention Program promulgates the food and beverage industry’s false paradigm and overlooks the primary role of sugar consumption in chronic disease causation. To wit, it suffers from at least three fatal flaws:
1. The DPP excludes normal weight individuals with high blood sugar. Type-2 diabetes is extremely deadly for everyone, not just the overweight. Some studies suggest that normal weight diabetics may even face a higher risk of death than overweight or obese diabetics[iv]. Yet the DPP requires an overweight body mass index to participate. Why?
2. The DPP measures success exclusively in weight loss, not changes in blood sugar . Isn’t a diabetes prevention program a failure if HbA1c remains high despite weight loss? On the other hand, if HbA1c falls below 5.7, but weight stays constant, isn’t the program successful?
3. The DPP ignores added sugar and instead focuses on lowering fat intake. For example, Session Three mentions fat 143 times and sugar just twice[v]. Session Four follows the same pattern. This ignores a growing body of evidence connecting added sugar to type-2 diabetes[vi] and linking low-carb, higher-fat diets to diabetes reversal[vii].
Gallup recently estimated that 11.6% percent of adult Americans have been diagnosed with diabetes, up from 10.6% in 2008. The CDC recently announced that 100 million Americans have diabetes or prediabetes. If Gallup’s statistics are any indication, the CDC’s figure may be an underestimation[viii]. The Diabetes Prevention Program falls far short of an effective response to our national diabetes crisis. It may even exacerbate the problem by further diverting America’s attention from the role that added sugar plays in our national chronic disease crisis.
How many Americans must develop type-2 diabetes before we confront its true causes?
Russ Greene,
Director of Government Relations and Research
CrossFit, Inc.
[i] Chronic disease is responsible for 70% of American deaths yearly according to the CDC: https://www.cdc.gov/chronicdisease/index.htm. 2,712,630 American deaths occurred in 2015 according to the CDC: https://www.cdc.gov/nchs/products/databriefs/db267.htm. 70% of 2,712,630 is roughly 1.9 million.
[ii] A plentitude of sources supports this assessment, to include “Sugar Industry Influence on the Scientific Agenda of the National Institute of Dental Research’s 1971 National Caries Program…,” as well as the news article “Coca-Cola Funds Scientists Who Shift Blame for Obesity Away From Bad Diets,” and the study “Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents.”
[iii] The Obese Without Cardiometabolic Risk Factor Clustering and the Normal Weight With Cardiometabolic Risk Factor Clustering” http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/770362
[iv] See “Association of weight status with mortality in adults with incident diabetes,” “The obesity paradox in type 2 diabetes mellitus: relationship of body mass index to prognosis: a cohort study,” “Body mass index and the risk of total and cardiovascular mortality among patients with type 2 diabetes: a large prospective study in Ukraine,” “Body mass index, diabetes, and mortality in French women: explaining away a ‘paradox,’” “Association between BMI measured within a year after diagnosis of type 2 diabetes and mortality,” “Obesity paradox in people newly diagnosed with type 2 diabetes with and without prior cardiovascular disease,” “Body mass index and the risk of all-cause mortality among patients with type 2 diabetes mellitus.”
[v] “Session 3: Three Ways to Eat Less Fat and Fewer Calories”: https://www.cdc.gov/diabetes/prevention/pdf/curriculum_session3.pdf
[vi] “The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data”
[vii] Virta Health recently published “A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes”
[viii] CDC diabetes figure “assumes that the prevalence of diabetes in 2015 was the same as it was in earlier periods (2011–2014).” This is an unmerited assumption and it is likely one reason the CDC’s estimate of diagnosed adult diabetes cases falls far short of Gallup’s. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf
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