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Re: [IP] CDC: Diabetes becoming epidemic : Rise in cases linked to increasing...

Jim Handsfield wrote:
<<There's a fundamental problem with the public health/research community that
I've been trying to impact - unsuccessfully so far, and that is the use of
some technical terms that have a different meaning for the general public.
Specifically, the use of the word "risk" when it comes to weight, race, sex,
activity, etc., and type 2 diabetes.  When public health professionals use the
word, it means a statistical association which may or may not have a causal
relationship.  Unfortunately, to most people, risk is directly associated with
a cause and effect.  IOW, when a public health professional talks about
obesity as a risk factor for type 2, most people naturally assume that they
are saying obesity *causes* type 2.  In fact, that is not what is being said
at all.

Unfortunately, most of the public health professionals I've spoken to only
repeat that last without seeing that those whom they are trying to help find
the word offensive, and that's not the way to present one's work to the people
they're trying to help.  But maybe if I say it often enough to enough people .>>

I think this is a really interesting point, and I've been pondering 
it off and on since I read it. It makes me think about the phrase 
"epidemic of obesity," which has now become quite a cliche 
(and which I really hate, but that's another matter). I think that 
one of the things that people don't understand about this phrase 
is the significance of the word "epidemic." By using that word, 
public health people -- I *think* -- mean something more specific
than "it's a large and growing problem," which is the way most
people interpret it (or "it's a very scary problem," which is another
way that people often see it). What I think is meant by "epidemic"
is that the increase in rates of obesity has some of the demographic 
qualities of an epidemic of an infectious disease, and thus public 
health measures are needed to combat it. I don't think that is 
conveyed to most people.

As Jim says, the *causal* connection between weight and diabetes
is not clear. It's possible, for instance, that weight itself is another
symptom of an underlying problem, caused by poor diet and 
sedentary behavior. Focusing on "obesity" encourages people to 
think in terms of dieting, rather than making long-term, sustainable 
changes in their behavior.  It encourages people to think that they've 
failed if they don't lose weight, even if they have made changes that 
make them feel better and improve their health.

This also relates to the "if you lose weight, will your diabetes dis-
appear?" question that we all hate so much. It's all part of the focus
on a visible end goal, rather than process.

What I'd really like to see, though, is more discussion of more 
general, systemic approaches to this problem -- whatever the
problem is. What's causing Americans to get fatter? Increased 
intake of calories, especially higher-fat diets, and increasingly 
sedentary behavior. But that begs the question. We know that 
eating too much and not exercising causes weight gain. But 
what is *causing* people to eat more, to eat unhealthy food, 
and to get less exercise?  We tend to see weight as an indivi-
dual problem; and it is -- partly. But a change like this -- a 
rapid, broad change that has been taking place steadily over 
many years, and that shows no signs of slowing or reversing -- 
cannot be simply a personal, individual problem. There must 
be some economic and social changes that are contributing to 
it. I have some ideas about what these are (aggressive marketing 
of fast food, junk food, and soft drinks to children; growth of
portion sizes in restaurants; more meals eaten in restaurants; 
the proliferation of snack food businesses leading to a constant 
temptation to snack; growth of a general attitude that constant 
snacking is normal behavior; tv and computers encouraging 
people to stay home instead of going out and being active; the 
many factors that encourage people to walk rather than drive: 
urban blight, urban sprawl, fears about personal safety, etc.)
I even know of research that supports some of these theories. 
But no matter what the causes are, if we want to reverse this 
trend, we have to change not only individual behavior, but 
the social and economic conditions that enable it. (First step,
in my opinion: stop the advertisement and sale of junk food
in our schools!)

Obligatory pump reference: pumps make extra snacking
muuuuch easier. Sigh.

Congratulations! You've made it to the end. My twin pumps
Castor and Pollux were NOT implicated in this post. They are
usually silent except for the occasional discreet beep.

Another long post brought to you by,

/Janet L.

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