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CLINICAL DIABETES
VOL. 14 NO. 2 MARCH/APRIL 1996

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E D I T O R I A L

The Prevention of Diabetes is Everyone’s Concern

Alan J. Garber, MD, PhD, Editor

The National Institutes of Health and the American Diabetes Association have embarked upon major research programs focusing on an elucidation of the genetic components of diabetes, together with interventional trials designed to prevent the appearance of diabetes in high-risk individuals. This is surely a worthy goal.

Unfortunately, diabetes is only one of a number of related causes of atherosclerosis in America. Atherosclerosis itself is the leading cause of death and disability and is the result of diseases such as diabetes, hypertension, dyslipidemia, hyperlipidemia, and exogenous obesity. Most commonly, it is also the result of chronically poor lifestyle choices. Therein lies the rub.

Despite innumerable public health campaigns focusing on cholesterol, blood pressure, blood sugar, and the like, the underlying problem of obesity in America compounds itself daily. Obesity is not limited solely to certain minority sub-populations, although it is far more prevalent in those sub-populations than in the general population. The etiology of this obesity clearly derives from multiple, usually interactive causes. These may include certain characteristics of the culturally diverse sub-populations of America. as well.

Regardless, it seems clear that virtually every aspect of our present society conspires to worsen obesity in America. In fact, it would seem that as we multiply the number of television channels available—initially on routine (VHF) channels and later with UHF tuners, cable, and now satellite channels—so, too, do we increase the number of adipocytes. Whether this results from a compensatory increase in feeding while watching television is an arguable, collateral condition, as well. Certainly, individuals seem to do almost everything imaginable while watching television, from talking on the telephone to reading the newspaper, to taking multiple grazing trips to the kitchen.

Corresponding to this obvious potential for increased food intake, however, is the equally disturbing element that virtually everything about American society has become sedentary. Increasingly, our service-oriented economy renders service by way of computer monitors and other forms of electronic equipment, which are used in fundamentally sedentary positions. Regular recreational exercise seems to be diminishing in terms of its popularity and acceptance by otherwise healthy individuals. Patients with known diagnoses, such as diabetes, do marginally better with exercise programs, if at all.

Unfortunately, television has begun to further compound our present difficulties. Commercials are now appearing on television not only for sweetened children’s cereals and other prepared foods that are less sound nutritionally than pre-existing alternatives, but also for liquid nutritional supplements. The hypothesis advanced in these commercials is that many Americans, especially those participating in sports and the elderly, are undernourished or poorly nourished and would have a better life with caloric supplementation, which is basically more calories.

While it is a virtual certainty that, in America, any individual able to play sports or having a television set is adequately nourished, it is also equally certain that they are very likely over-nourished. There may be patterns of disnutrition present in American society, but the use of caloric supplements seems unlikely to correct those nutritonal imbalances. More likely, such supplements will only exaggerate the condition, since their use continues a pattern of food choices and lifestyle decisions that have produced the current epidemic of obesity in America.

In light of this inexorable deterioration in the size of Americans, it seems clear that aggressive public health efforts must be pressed at every level with regard to food limitation and exercise. Perhaps we should censor television not with a V-chip to exclude violence, but rather with an F-chip to exclude the advertisements for obviously poor food choices that characterize American television.

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