The worldwide diabetes epidemic and its related precursor, obesity, are the fastest growing public health menaces of the 21st century.

Diabetes mellitus is a chronic condition resulting from the body’s inability to properly control blood sugar (glucose). Normally, the body controls the glucose level with a hormone produced in the pancreas called insulin. Those who have diabetes have either lost the ability to produce enough insulin, or the cells in their body no longer respond properly to the insulin that is being produced.

More than 90% of diabetes cases in the US today are Type 2, and less than 10% are Type1.

Diabetes was well known to the ancients, but the current epidemic of Type 2 diabetes is a phenomenon of modern living. It is largely the result of eating an unhealthy diet combined with a sedentary lifestyle. As a result, diabetes is nearly four times as common today as all types of cancer combined, and it causes more deaths each year than breast and prostate cancer combined.

More than 25 million Americans already have diabetes, and more than double that number have blood sugar numbers high enough to classify them as suffering from pre-diabetes. That means that they are likely to develop the full blown Type 2 diabetes in the near future if they do not make the necessary changes in their diet and lifestyles to prevent it.

Type 1 and Type 2 diabetes have many of the same symptoms and potentially deadly consequences, but different causes. Type 1 diabetes is also known as “juvenile diabetes” because in most cases it appears in childhood, in contrast with Type 2, which used to occur only in adults, which is why it was formerly known as adult-onset diabetes.

Type 1 is an autoimmune disease, like Rheumatoid Arthritis and Lupus, in which something triggers the body’s own immune system to attack the insulin-producing beta cells in the part of the pancreas known as the islets of Langerhans.

Type 1 cannot be cured, but it can be effectively managed. Proper insulin therapy, combined with regular monitoring of blood sugar levels, can allow people with Type 1 diabetes to lead a normal and healthy life.

One of the most insidious aspects of Type 2 diabetes is that by the time people are diagnosed with it, they may have already developed a serious long term complication of the condition. Type 2 doubles the risk of cardiovascular disease, which ultimately kills 52% of people with diabetes. People diagnosed with Type 2 also have double the risk of suffering a stroke within 5 years. Almost one in three will eventually develop kidney disease, and diabetes is one of the leading causes of adult blindness.

Diabetes is also associated with circulation problems in the lower extremities. This can result in the slow healing or infection of wounds on the feet and legs. This is further complicated by the fact that high blood sugar due to diabetes can cause damage to the nerves that sense pain. This means that diabetes patients may not realize that they have a wound on their leg or foot until after it has become dangerously infected. This can ultimately lead to the need for amputation.

Type 2 diabetes is also a condition related to aging. Approximately 20% of the population over 60 have the condition, and an equal number have its precursor. It is no longer called “juvenile” diabetes because of the shocking relatively recent result of the obesity epidemic, the discovery of Type 2 diabetes, for the first time, in grossly overweight teenagers and young adults.

Type 2 is typically treated with oral medications such as metformin, and it, too, requires the monitoring of blood sugar levels. The good news is that pre-diabetes or mild cases of Type 2 can also be controlled through appropriate changes in diet and lifestyle and weight loss. These are more effective, but require a lot more work and discipline, than taking pills. In fact, there is evidence that Type 2 diabetes can actually be reversed, in at least some cases, with sufficiently aggressive and strictly observed diet and lifestyle changes and weight loss.

There are other types of diabetes, the most common being gestational diabetes, a temporary condition which affects 2-5% of pregnant women and generally subsides after the baby is born. The symptoms are similar to those of Type 2 diabetes, and women who have had gestational diabetes are at higher risk of developing Type 2 diabetes later in life.

Women with gestational diabetes must be treated and closely monitored, because of the potential danger from the diabetes to the health of both the mother and the fetus. Gestational diabetes in the mother puts the baby at greater risk for high birth weight, cardiac and central nervous system problems, respiratory distress and skeletal muscle malformations. The damage done to blood vessels could impair the function of the placenta, causing fetal distress requiring early delivery through the induction of labor or cesarean section.

Last week I shared a letter from a gentleman who felt it was appropriate to comment on people’s weight.  He felt that not doing so facilitated the problem. “In our effort to spare the feelings of the fatsos, we have become facilitators of their irresponsibility.”  He felt that commenting on weight would help people take responsibility for how their over- weight condition effects those around them. “But if, indeed, one cannot even so much as allude to the issue of weight when conversing with a fat person, what then might induce fat people to take responsibility for the effects of their physical conditions upon other people?”

He cited overweight houseguests who could not care for their personal hygiene as one example. Overweight passengers in cars and on airlines were another. “And then there is the problem of the person in the back seat of my car, who is too fat to buckle him/herself into the seatbelt.  If he/she doesn’t buckle up, then, in the event of a crash, he/she becomes a projectile in motion (and a very heavy one, at that, which would crash into the front seat occupants (including me) and cause grievous if not lethal damage.

“On a more individual level, if I cannot even obliquely mention weight, how am I to deal with the big, fat woman sitting next to me on the airplane, whose flab protrudes out into my own seat so I cannot comfortable sit in it? Which wouldn’t be so bad, except that it’s a night flight, and the cabin lights have been switched off, but I cannot stay up and read because her big size obstructs the reading light. 

“Can I say anything to my fellow passenger without hurting her feelings?  Am I supposed to complain to the flight attendant?  And yet, the fatso lobby whines that it is discriminatory for the airlines to require people who cannot fit into one airline seat to purchase two seats to accommodate their big size.”

Rising insurance costs, which he attributes to the “obesity epidemic” was another way in which he sees people’s weight impinging on others. For these reasons he feels that there is merit in making comments to overweight people.

Dear TVQ,

Thank you for your comments. I appreciate hearing from someone with the opposite point of view. I think you raise some valid issues. Obesity does impact on more than the overweight person.  It can make others uncomfortable.  But are there other ways of dealing with the problem that may be more effective than making the negative comments, which, I am told, have no positive effect on weight loss at all.

If a houseguest makes you uncomfortable for any reason, you do not have to invite them into your home. If you feel transporting someone in your car is a safety hazard for you or them, you do not need to give them a lift. And if your seat on the airline is not comfortable, you can quietly talk to the stewardess about changing it. 

There is no question that any health issue impacts on us as a society and affects our health costs. It is as true of smoking, drug addiction, mental illness, chronic illness, hypertension, etc., as it is for obesity. The impact of almost all illnesses would be reduced if we as a society would strive for normal weight by eating better, exercising more, learning to react better to stress and in general, were more mindful of our bodies and took better care of them. 

Shall we only insure those with no ill health potential or those that pass a criterion designed to cost the insurance company the least amount of money? Or do we have a commitment to help everyone with their health needs − even those that may not be able to foster optimum health for themselves at the moment?

Further, I think you may have missed the point of my column. It appears that these hurtful comments do not help the person deal with their weight problem. Often they can do just the opposite. If that is the case, then why make the comments in the first place? It is not facilitating a problem to keep quiet when the comments serve no constructive purpose and just exacerbate the issue.

If, indeed, comments on a person’s weight contributed to them becoming healthier and starting a program of weight loss I would advocate doing so in a kindly and effective manner. But they do not. These comments accomplish nothing, and as I have said, often make the situation worse. That is why I am so against them.

A dialogue on any topic is always constructive when it is presented in a respectful manner without name-calling. Different points of view are always challenging and enlightening and can often change a person’s opinion. Using derogatory words and descriptions often serves to lessen an argument instead of bolstering it. But I thank you for contributing to the discussion and always welcome a difference of opinion.

Ann

You can reach me at annnovick@hotmail.com

Our Yeshivos and Bais Yaakovs face the growing rate of childhood obesity. “Overweight children are more likely than their normal-weight counterparts to grow into obese adults. Obesity can lead to high blood pressure, high cholesterol, stroke, sleep apnea, type 2 diabetes, heart disease, bone and joint problems, asthma, and several types of cancer,” says Chaya Stern, RPA and nutritionist.

Some might blame sedentary lifestyles and unhealthy school lunches; perhaps the Jewish community’s food-centric culture and elaborate Shabbos meals are to blame. Regardless of what has led us down this road, childhood obesity is becoming increasingly common, and our schools must step in and supplement the parents’ efforts to keep their children healthy.

Most schools give their students a 30-minute gym session once a week, but many contend that is simply not enough; Stern is one of them. “Schools need to ensure that students are participating in physical education on a daily basis,” she says. “The schools have been remiss in addressing this problem and they have the power to do a lot more than they are.”

Stern recommends banning sodas and other sugary soft drinks from school vending machines and replacing unhealthy snacks with more nutritious options. She also suggests that the schools “include at least two servings of fruits and vegetables in their meals, serve foods that are low in fat and high in essential nutrients such as fiber, calcium, and protein.”

Stern advises that the schools incorporate chummus and whole wheat pita into their menus, especially now that peanut butter is no longer an option. Tuna and salmon salads are also tasty options. “The low-fat tuna should also have a lot of vegetables cut into it such as celery, carrots and cucumbers.” It is important, too, that the school lunches include lots of vegetables, and have a balance of complex carbohydrates, proteins, and healthy fats.

Rabbi Hillel Mandel of the Clifton Cheder in New Jersey agrees. “We suggest and monitor the food eaten in school,” says Rabbi Mandel. “We tell the parents to send in fruits, vegetables, and non-sugary cereals for snack,” he explains. But they do allow for special occasions. “A pizza at a siyum is not the end of the world,” he notes.

Terri Mizrachi at Magen David Yeshiva, in Brooklyn, also notes the significance of this issue. “We are very concerned,” she says. “There’s always a vegetable salad at lunch, and we ask the parents to send fruits and vegetables for snack.”

“Perhaps schools should bring in professionals such as dieticians or exercise instructors to teach children about healthy lifestyle choices,” suggests Stern. Let’s hope schools seriously consider instituting some of these changes to provide our children with a healthier future.