The diabetes epidemic – the problem
Type 2 diabetes (T2D) is the most common type of diabetes, affecting 95% of American diabetics. There are 35 million U.S. citizens with T2D, over 10% of our population, according to the American Diabetic Association (Nov. 1, 2023.)
The annual cost of diabetes in the U.S. last year was $413 billion, accounting for one of every four health care dollars spent in the U.S. and that cost is increasing each year. At the same time, we have an obesity epidemic in the U.S. Nearly ninety percent of people with T2D are overweight or obese according to the NIH. Of special significance is the fact that childhood obesity rates have tripled over the past three decades and are expected to continue to increase. One in six youths in the U.S. is obese and one in three children are overweight or obese.
According to Harvard Health, childhood obesity has been called one of the most serious public health challenges of the 21st century. Obesity can harm almost every system in a child’s body – heart and lungs, muscles and bones, kidneys and digestive tract, as well as the hormones that control blood sugar and puberty, and can also take a heavy social and emotional toll.
Overweight or obese youth are at higher risk of remaining overweight or obese into adulthood. According to the Mayo Clinic, one of the best ways to reduce childhood obesity is to improve the eating and exercising habits of one’s entire family. As far as eating and food is concerned, we are learning more about the contribution to childhood obesity and T2D, of ultra-processed foods which are said to make up about 73% of our food supply.
According to Senator Bernie Sanders, for decades we have allowed large corporations to entice children to eat foods and beverages loaded with sugar, salt and saturated fat, deliberately designed to be eaten, and which can be as addicting as alcohol and nearly as addictive as cigarettes. Hall, at the NIH, (May 16, 2019) published a randomized, controlled study that found that people who ate processed food ate more calories and gained more weight than when they consumed a whole food diet that was unprocessed.
According to Nutrition Action magazine (Sept.-Oct. 2023) I will define this approach to food groups:
Unprocessed or minimally processed foods – fruits, vegetables, beans, nuts, seeds, eggs, juice, meat, poultry, seafood, grains, pasta, yogurt, milk tea, coffee. Most are obtained directly from plants or animals.
Processed culinary ingredients – sugar, honey, maple syrup, butter, lard vegetable oils, salt, etc.
Processed foods – salted nuts, cured meats or fish, canned or bottled fish, some packaged vegetables and breads (breads from a bakery, okay) beans or fruit, unpackaged cheeses.
Ultra-processed foods – packaged breads, most breakfast cereals, bars, flavored yogurts, ice cream, chocolate, candies, cookies, pastries, margarine, frozen pizza, sausages, hot dogs, chicken nuggets, most sugary drinks, instant soups, sauces, noodles, etc. These are industrial formulations. Most commonly used foods in this group include nearly all packaged cereals and breads, fats, condiments and sauces (ketchup, salad dressings, soy sauce) sweet snacks, desserts and beverages.
As noted by Nutrition Action magazine (July 20, 2023) who would have guessed that a 12 oz can of Coke has 10 teaspoons of sugar and a 20 oz bottle has 16 teaspoons, way above the daily recommendations. It is said that 1-2 cans of coke a day could increase the chance of T2D by 26% and imbibers could be more than 27% likely to be overweight or obese than a non-drinker.
The largest sugar drink companies spend more than $4 billion per year on marketing and millions on campaign contributions to elect candidates who will protect their interests. It is claimed that the purpose of ultra-processed foods is “to replace all the other food groups while maximizing food industry profits.”
Ultra-processed foods are attractive because they are affordable, because of low-cost ingredients. They are also convenient and engineered to have craving-like palatability and are aggressively marketed. They are distinguished by additional industry techniques like hydrolysis, hydrogenation, and extrusion along with ingredients like emulsifiers, thickeners, flavors, dyes and other additions that are rarely found in a home kitchen. Studies show that people seem to prefer foods with more calories per bite (potato chips, chocolate) and were “hyper-palatable”, which is common in ultra-processed foods, which were faster to consume and contained more contaminants and additives that would improve taste and increase sweetness and textures that improve each small, savory bite. Our bodies absorb more calories when we eat ultra-processed foods.
Also of concern with ultra-processed foods is the fact that, according to the Mayo Clinic (July 25, 2023) these foods have been linked to colorectal, ovarian and breast cancer.
Gearhardt et al., British Medical Journal (Nov. 14, 2023), pointed out that ultra-processed food addiction is 14% for adults and 12% in children. Studies show that refined carbohydrates or added fats, such as sweets and salty snacks are strongly implicated in behavioral indicators of addiction such as excessive intake, loss of control over consumption, intense cravings and continued use despite negative consequences.
Thus, ultra-processed foods appear to be addictive substances that have a considerable effect on children. Added to this is the food industry that spends billions of dollars marketing these appealing, low cost, convenient foods directly to disadvantaged communities. Children and teens view 4,000 food and beverage ads on TV each year, about 10 ads each day.
It would be difficult to eliminate ultra-processed foods from our diet because it makes up so much of our diet and much of what we like to eat. Most experts won’t say what the ideal amount of unprocessed foods in our diet should be. We can do best by opting for other foods that don’t require much preparation, foods with just two or three ingredients instead of 10 or more ingredients as seen on food package labels for these ultra-processed foods.
There are other approaches to solving this problem and thus decreasing childhood and adult T2D. The NIH estimated that if the U.S. banned food advertising marketed to children, childhood obesity would decrease by 18% and thus lower childhood and adult T2D. Banning junk food ads to children would help. Many countries have increased taxes on sugar sweetened beverages and some have started taxing ultra-processed foods, with positive results. Better labeling of these food percentages on the food package would help.
The government could put limits on salt content of foods. Healthier food standards for school meals would help. Senator Bernie Sanders (Dec. 15, 2023) noted that in the 1980s, Quebec banned junk food advertisements to children. Today, Quebec has the lowest childhood obesity rates in Canada and the highest consumption of fruits and vegetables.
Parents can help by steering their children away from ultra-processed foods and sugar laden cola drinks. Northeastern U. has a database called TrueFood (TrueFood dashboard) that tells you just how processed food items are. Scores of 0 to 100 (highly ultra-processed) helps you choose. Parents can also help influence the content of school meals.
Dr. Carl E. Bartecchi, MD, is a Pueblo physician and clinical professor of medicine at the University of Colorado School of Medicine.
This article originally appeared on The Pueblo Chieftain: The diabetes epidemic – the problem
