The globalisation of diabetes and obesity

By Kelly Close/San FranciscoGiven the complexity of the conflict in the Middle East, it might come as a surprise that the US and the entire region have a clear enemy in common: type 2 diabetes.With one in seven Americans expected to be living with diabetes by the year 2025, according to a study commissioned by Novo Nordisk, it’s clear that even one of the world’s most advanced health systems still struggles to control – let alone manage – the type 2 diabetes epidemic. And, as the world becomes more integrated, many of the West’s not-so-healthy habits have crossed borders, contributing to a dramatic increase in obesity and type 2 diabetes in the Gulf Co-operation Council (GCC) countries.In an upcoming report, the diaTribe Foundation specifically examines the GCC’s alarming prevalence of type 2 diabetes and obesity, up to 24% and 41% of the population, respectively. To illustrate, that’s equivalent to every person in New York City, Washington, DC, Boston and Atlanta having type 2 diabetes, or the entire populations of Ohio and Tennessee being obese.With numbers only expected to rise, this epidemic has reached “time bomb” proportions. And amidst all of our cultural differences, the factors contributing to that rise are strikingly familiar.For starters, there’s an ever-expanding selection of easy-access food options available. During diaTribe’s time spent in the Middle East, one of our writers heard from residents of Dubai’s Burj Khalifa, the world’s tallest building, that they could visit the attached Dubai Mall and eat at a different restaurant every day for four months without ever having to go outside. And it’s not simply the quantity of restaurants, it’s the quality of food served there. Take, for instance, the introduction of Western food chains, and it’s easy to see how there could be a problem.In America, we can relate. We have the “Push For Pizza” app, which allows the user to order a delivery pizza in less than 30 seconds. Fast. Easy. But is it a healthy choice?Diet is just one component contributing to the epidemic in the GCC. Inadequate exercise, an absence of enough healthcare providers earning a certification as a Diabetes Educator (only 28.6% of respondents in a cross-sectional study by the International Diabetes Fund, compared to 73.5% in North America), and infrequent patient interactions are also to blame. But there is one factor that is curiously both similar and different between the US and the Middle East: the cultural stigma associated with obesity and disease.Abroad, this comes from cultural beliefs and expectations promoting a large body size and shape. According to an IDF report on cultural considerations with regards to diabetes in the Middle East, “being overweight in the Middle East is associated with high status and desirability”. The report also noted that weight loss is generally undesirable because it “raises suspicion that a person has a serious illness.” These social norms may discourage people in the Middle East from thinking about their weight and body size as a measure of their health in favour of a measure of beauty.At home, we don’t generally share the same perspective on being overweight. Instead, obesity is met with cruel words, and people with diabetes, both type 1 and type 2, are often urged – spoken or unspoken – into testing their glucose or injecting insulin away from the public eye.Complacency or disgust – neither moves us closer to a solution. These stigmas only guarantee that a public dialogue is stifled. They ensure that the facts that we do have about this currently incurable disease are silenced. And they keep influencers in the health and policy communities from giving diabetes the attention that it deserves.A first step in solving the obesity and diabetes crises anywhere involves increasing the number of native-trained endocrinologists while expanding education opportunities for patients and primary care physicians. We need an increased emphasis on preventive medicine, particularly a renewed focus on diet and physical activity, using smart technology programmes like Omada, which pairs enrollees with a online health coaches and support groups and uses customised curriculum and games to alter how people approach exercise. And there should be system-wide changes in policy to address health disparities on both socioeconomic and geographic levels.But action doesn’t begin and end with doctors. Society needs to examine the way we think about infrastructure, placing a higher value on neighbourhood walkability and the accessibility of full-service grocery stores. Then we should consider our culture – the way our children think about junk food and the ways that we perceive and help (or hurt) those suffering from obesity or diabetes.As the International Diabetes Federation and groups in the GCC step up their efforts to reduce the social stigma associated with these conditions, I’d call on the public to take the simplest action possible – be empathetic.There is plenty that many Americans will never understand about Middle Eastern culture. There is plenty that you might not even understand about a day in the life of an American person who has type 2 diabetes, for that matter. But committing to end discrimination and become a productive part of the conversation would be a welcome first step. ♦ Kelly Close, a leading diabetes patient advocate, is founder of The diaTribe Foundation, a non-profit organisation committed to improving the lives of people living with diabetes and prediabetes and advocating for action .