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Rethinking diabetes and obesity

The obesity and type two diabetes epidemic - where to from here? Dr Joe Kosterich examines current thinking about chronic lifestyle conditions and sets his sights toward the future.

  The term epidemic gets bandied about with much abandon these days. Let’s look at the definition of the term - a disease which “affects many people at the same time and spreading from person to person in a locality where the disease is not permanently prevalent”. This of course pertains to infectious disease for which the term was first coined.

  So, when we hear about epidemics of obesity and type two diabetes, we know what is meant - lots of people have it - but these problems are not spread person to person nor does it look like they are “not permanently present”.

  Being a stickler for correct terminology aside, the main stay of general practice has changed over the last few decades from treating largely acute illness to managing chronic disease. In turn, there are connections between many of these conditions. Heart disease and stroke are related (amongst other things) to type two diabetes and in turn this is related to obesity.

 Over the last 30 years there has been a significant increase in rates of type two diabetes and obesity. Many theories have been put forward as to why this is the case. One that seems counter-intuitive but gaining strength is that current dietary guidelines which encourage a low-fat diet might be part of the problem rather than part of the solution. It is worth noting that the introduction of low fat dietary guidelines coincided with the rise in these problems.

 The PURE study release earlier this year, published in The Lancet followed 135,000 people over seven years in 18 countries. It found a reverse association between fat consumption (including saturated fats) and heart disease stoke and mortality. Those on low fat diets had higher rates. This is the opposite of what might have been expected.

 As with all epidemiological studies correlation does not equal causation but a large study should give us pause to reflect. In 2013 another big study looking at rates of type two diabetes in 175 countries over a decade found a strong correlation (as strong as the original work on lung cancer and smoking) between consumption of refined carbs (sugars). This was about consumption of refined carbs separate to obesity.

 We know that 75% of the disease burden in Australia is chronic lifestyle conditions. Yet we have a tendency to look for pharmaceutical rather than lifestyle solutions. There are often good reasons for that. But it can also be perceived by both the doctor and patient as a simple fix.

 Our understanding of medicine is never static. What we believed in the past can be disproved by new findings. Taking three steps back it is evident that what we have recommended over the last 30 years, diet wise, is part of what has led us to the current situation. In turn, this means that we need to be questioning, rather than simply accepting current thinking. The next five years will be interesting to watch. What we advise our patients with diabetes in the 2020’s may be quite different to what we do today.


Jow KosterichDr Joe Kosterich MBBS
Doctor, speaker, author of three books, media presenter and health industry consultant, Dr Joe Kosterich wants you to be healthy and get the most out of life.He is a regular on Channel 9 and radio, writes for various medical and mainstream publications, as well as maintaining a website and blog providing health information. He is the health ambassador for locally grown fresh potatoes. Dr Joe also gives practical motivational health talks for the general public and organizations.