It’s refreshing to live in Ukraine where I don’t have to regularly see obese children and as a doctor have to try and negotiate this difficult subject with their mothers – an exercise in communication that normally leaves all parties unhappy.
The growth in obesity in both adults and children in America and Western Europe, indeed in nearly all affluent countries, has been huge and quite apparent to me in my 35 years as a doctor. It is for example now estimated that some 30% of adult Americans, some 10% of infants and toddlers, and some 18% teenage children are classified as obese. To give a clearer picture if you are 183cm tall (6 ft) you should weigh no more than 83 Kg (183 lbs). If you weigh up to 100 Kg (220 lbs) you are overweight and only over that classified as obese.
The growth in obesity has also been mirrored by a growth in diabetes and it is not unusual to see what we call maturity onset diabetics at the age of 35 whereas some 30 years ago the age of onset was more often 60. The UK has a 7% annual increase in the number of diabetics, now some 4% of the adult population. Diabetes is a serious disease requiring expensive drug control and carrying increased risks for heart disease ( estimated to be upto ten times greater) kidney disease and others. Not only does obesity cause diabetes but also excess wear on our joints and spine and for many a loss of attractiveness, self esteem and subsequent depression.
For Ukraine the financial onus of an increase in the diabetic population would put severe strains on the already precarious health care system. It is estimated the USA spends some USD116 billion to treat and prevent diabetes and its complications each year ( some USD 375 per person and USD 7400 for each person with diabetes) and that will increase by some 30% by 2025. Ukraine spends just USD145 for each person with diabetes or an estimated USD500 million from its current budget.
Ukraine is at risk from an increased growth of obesity and diabetes for several reasons. Firstly there has been a huge growth in the availability and consumption of refined carbohydrate products which are now readily available in all shops and supermarkets for both children and adults, and this has been evident right across the country not just in Kyiv. Ukrainians have moved away from a diet which was traditionally heavy in unrefined carbohydrates such as rough ground wheat, buckwheat, potatoes and root vegetables to one richer in refined carbohydrates and sugars. Paradoxically the move away from fatty food, which gram for gram provide our best energy source, but which have been strongly implicated for causing heart and cardiovascular disease, has often caused people to source energy through refined carbohydrates driving an increased risk of obesity and diabetes and in turn increasing the risk of heart disease. It is interesting to perceive that Ukraine already has a prevalence of adult diabetes of 7.6%, considerably more than the UK despite its less elderly population. Another factor in Ukraine is the move towards a more sedentary lifestyle and it is noticeable that most school children spend only short periods of time each week undergoing strenuous physical excercise and many adults in cities do little or no excercise.
We can consider that we have a finite amount of the hormone insulin in our systems, the amount is probably genetically determined as we know that Indian’s for example have a high incidence of diabetes as do their genetic peers in the Middle East. Diabetes also strongly runs in families. The amount of insulin we have is decreased in proportion to the amount of carbohydrates and sugars we consume. Furthermore high intakes of sugars can cause insulin resistance, a process where the insulin we have doesn’t work so well and which drives both diabetes and obesity.
Diabetes is an extremely preventable disease and both government, individuals and parents have important roles to play. Government can discourage the intake of refined carbohydrates by food warnings and advertising and ultimately by taxation – sugar being in effect as dangerous as both cigarettes and alcohol. It can also foster educational programmes in school which teach about healthy diet . Individuals and parents are mostly responsible for preventing obesity and diabetes they should keep their weight within normal limits, take some form of daily excercise – brisk walking is excellent, and preferably some weekend excercise. Parents should discourage the consumption of sweet foods and drinks for children especially as it appears that sugar is quite addictive even to young children and not rely upon it as an energy source. Individuals should have a sense of their correct weight and decrease their food intake to maintain it if they are overweight. Those with a low risk of cardiovascular disease should rely more on a balanced diet using unsaturated fat and not refined carbohydrate as an energy source, whilst more reliance should be placed upon traditional and unrefined carbohydrates.
Ukraine’s current prevalence of diabetes and the expectation that it will radically increase should cause concern to both government and population alike. The almost total avoidance of sugar, cakes, biscuits and sugar containing foods and a regime of some daily excercise is tough medicine but it brings with it considerable gains in terms of raised self esteem, physical fitness, less wear on our joints and spines as well as the knowledge that we will successfully avoid diabetes with all its complications and medications.