Time for change

Lack of com­mu­nity ed­u­ca­tion and in­for­ma­tion about type 2 is lead­ing to dis­crim­i­na­tion, writes Sherl Westlund, a direc­tor of Di­a­betes Re­search WA

Diabetic Living - - CONTENTS -

Type 2 and dis­crim­i­na­tion

An es­ti­mated 1 mil­lion Aus­tralian adults (that’s 1 in 20 of us) were liv­ing with type 2 di­a­betes in 2014–15. And glob­ally, ac­cord­ing to the In­ter­na­tional Di­a­betes Fed­er­a­tion, it’s es­ti­mated

425 mil­lion peo­ple had di­a­betes in 2017, and this fig­ure is ex­pected to in­crease to 693 mil­lion by 2040. With the cost of all forms of di­a­betes in Aus­tralia es­ti­mated at $14.6 bil­lion each year, it’s clearly in every­one’s best in­ter­ests to find an ef­fec­tive so­lu­tion to stop­ping the soar­ing rates of type 2 di­a­betes.

The dis­crim­i­na­tion that ex­ists against peo­ple with type 2 di­a­betes re­lates to the be­lief that it is solely linked to obe­sity and lifestyle is­sues brought about by an un­healthy diet and lack of ex­er­cise. It’s be­cause of this that many in the com­mu­nity be­lieve the so­lu­tion is as sim­ple as telling peo­ple with di­a­betes to lose weight and get fit. This ap­proach es­sen­tially blames those with the con­di­tion for cre­at­ing their own sit­u­a­tion – and leaves them feel­ing un­fairly judged and pow­er­less.

IGNORANCE LEADS TO SHAME GAME

The re­cently re­leased Am­cal 2018 Di­a­betes Care Re­view found that more than a quar­ter (27 per cent) of Aus­tralians sur­veyed be­lieved di­a­betes to be a self-in­flicted dis­ease and 1 in 7 be­lieved di­a­betes was largely avoid­able through sim­ple lifestyle changes. It also found that

1 in 3 of those with di­a­betes sur­veyed said feel­ings of em­bar­rass­ment and guilt for be­ing made to feel they brought the con­di­tion on them­selves were key rea­sons they had not spo­ken out and sought the emo­tional sup­port they needed.

A re­cent on­line poll by Di­a­betes Re­search WA also found that 3 out of 4 re­spon­dents felt other peo­ple blamed them for caus­ing their own type 2 di­a­betes.

This is­sue doesn’t af­fect just those with type 2 ei­ther. Those with type 1 di­a­betes are also of­ten caught up in this dis­crim­i­na­tion as the bulk of the com­mu­nity strug­gles to un­der­stand that type 1 and type 2 are dis­tinct con­di­tions with dif­fer­ent risk fac­tors.

SO WHY IS THE DIS­CRIM­I­NA­TION UN­FAIR?

Well, for one, the re­search shows that while some peo­ple might be able to avoid de­vel­op­ing type 2 di­a­betes by main­tain­ing a healthy weight and lifestyle, not every­one can.

The in­ter­na­tional di­a­betes com­mu­nity now be­lieves that around 1 in 3 peo­ple prob­a­bly won’t be able to avoid it, even if they make sig­nif­i­cant lifestyle changes.

Type 2 di­a­betes is in­cred­i­bly com­plex. Re­search so far tells us it’s likely to in­volve an in­tri­cate in­ter­ac­tion be­tween ge­netic and en­vi­ron­men­tal

The cost of all forms of di­a­betes in Aus­tralia is es­ti­mated at $14.6 bil­lion

each year

fac­tors, which is why even peo­ple at nor­mal weight with a healthy lifestyle can be at risk. Stud­ies have shown, for ex­am­ple, that a short pe­riod of mod­er­ate or se­vere un­der-nu­tri­tion dur­ing de­vel­op­ment af­ter birth can in­crease type 2 di­a­betes risk in adult­hood, that peo­ple per­ceive hunger dif­fer­ently, and that in­flam­ma­tory lung dis­ease can be a risk fac­tor for type 2 di­a­betes.

There is also much ev­i­dence to show that type 2 di­a­betes has a strong ge­netic ba­sis. Re­search shows hav­ing one par­ent with di­a­betes in­creases the risk of de­vel­op­ing type 2 by up to 40 per cent, and hav­ing both par­ents with it in­creases the risk by 70 per cent. Even hav­ing a sib­ling with it raises a per­son’s risk con­sid­er­ably.

While there is a lifestyle com­po­nent to this, it is be­lieved shared ge­netic fac­tors are also a con­trib­u­tor.

Al­though it is in­cred­i­bly im­por­tant to keep as­sist­ing and re­mind­ing peo­ple to live a healthy lifestyle, as it can help many peo­ple, the above few ex­am­ples demon­strate why telling peo­ple to change their lifestyle should not be the only strat­egy. It also em­pha­sises why fur­ther re­search is crit­i­cal if we are to un­cover how to pre­vent all type 2 cases.

BET­TER AC­CESS TO FRESH FOOD NEEDED

Even when con­sid­er­ing the 68 per cent of cases it is be­lieved could be pre­vented by main­tain­ing a healthy body weight and ex­er­cis­ing, the chal­lenges many peo­ple face in do­ing this are un­de­ni­ably large. In this mod­ern world, there are so many hur­dles that can make stay­ing healthy ex­tremely dif­fi­cult. Is­sues in­clude longer work­ing hours, the af­ford­abil­ity and avail­abil­ity of fresh food in some ar­eas, in­cred­i­bly savvy and of­ten un­der­hand fast-food mar­ket­ing cam­paigns, a lack of struc­tured nu­tri­tion ed­u­ca­tion in schools, emo­tional is­sues that can cause overeat­ing, and many more. All of these is­sues need to be ad­dressed to help tackle the dif­fi­culty some peo­ple have in main­tain­ing a healthy lifestyle.

STOP THE BLAME AND SHAME GAME

For all these rea­sons, the dis­crim­i­na­tion that is di­rected at peo­ple with di­a­betes is mis­guided – and it has to stop. It has to stop be­cause of the neg­a­tive im­pact it is hav­ing on those peo­ple who are the tar­gets and it has to stop so that the fo­cus can be put on pre­ven­tion and fur­ther our un­der­stand­ing of the con­di­tion and linked is­sues, rather than blame.

There is so much that needs to be done im­me­di­ately to help tackle ris­ing rates of type 2 – in­clud­ing de­sign­ing health­ier com­mu­ni­ties that make ex­er­cis­ing eas­ier and safer, tight­en­ing reg­u­la­tions re­lat­ing to junk-food mar­ket­ing, sup­port­ing our young kids to learn about nu­tri­tion, recog­nis­ing obe­sity as a med­i­cal con­di­tion, and en­sur­ing af­ford­able ac­cess to fresh fruit and veg­eta­bles. There’s no time for dis­crim­i­na­tion, there is work to be done.

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