Diabetes and how the dieticians failed

Prison is a dysfunctional system for dealing with mostly young men, many of whom have learning or emotional difficulties along with drug problems. The official system we have for dealing with diabetes seems much the same. The problem with prisons is that they do very little to address the problems that have put offenders in the dock in the first place. Diabetes treatments manage to be equally blind to the origins of patients’ metabolic problems.

This disjunction came sharply into focus last week while watching part 2 of the excellent BBC documentary series The Men who Made us Fat just after my return from the annual American Diabetes Conference. The program skilfully wove two strands together. The key marketing breakthroughs that combined to greatly increase both profits and the amount people were eating and the fate of the few scientists who investigated this change, which was to be ignored or to have their funding cut.

The winners have been the pharmaceutical companies who responded to the obesity crisis and the rising tide of diabetes with a range of new drugs – the equivalent to building new prisons, to continue the analogy, and recommending that the courts and others get offenders/patients locked up as soon as possible. Of course some villains have to be locked up for the sake of everyone else and the drugs undoubtedly are lifesavers for some cases but the interventions on offer to halt the steady snack filled progression to serious illness of millions has been lamentable.

 It began with popcorn

The program pinpoints the time and the place where the relentless expansion of our waistlines began – a cinema in Chicago where a marketing genius introduced the first extra-large popcorn box in 1967. It proved a win-win innovation punters felt they were getting a good deal, it cost the cinema pennies and sales soared.  All the subsequent developments – the supersize meal, counter service to speed up sales, larger cup sizes for drinks, the value meal, the upsize snackbars – all followed the same irresistible financial logic – people kept piing their plates because it seemed like a bargain and profits went up three four times.

The effect of this increased intake of calorie dense foods wasn’t a mystery. In 1974 one researcher reported how giving such food to rats promoted rapid weight gain. “We couldn’t get them to put on weight on regular rat chow but put them on something bought in the local supermarket packed with sugar and fat and they would eat until they were obese.” Like us, evolution has programmed rodents to gorge on this kind of food.

By the mid-90’s Professor Phillip James obesity expert and now an honorary member of the London School of Hygiene and Tropical Medicine was asked to compile a report about child obesity for the government. He wrote about the need for urgent action on the massive rise in their snack intake and sent it to health minister Tessa Jowell who responded by inviting him to a meeting with the CEO’s of 14 food companies who harangued him for four hours.

 Food companies get rewarded

Besides defending the freedom to choose, food companies claimed the problem of expanding children was not snacks and fast food but lack of exercise. However a research project that showed children were getting just as much exercise as they did decades ago was closed down. Other research showing that getting calorie dense foods made you want to eat more and how it was possible to overeat without knowing it, also got little attention.

Instead like prison officers promising rehabilitation, the nutrition experts and dieticians continued to recommend will power, weight loss and a low fat diet. Not only did this not lay a finger on the food companies but it rewarded them with whole new marketing opportunity – low-fat-foods. These, as tonight’s program shows, ensured a big increase in sugar consumption and continued waist expansion.

Just as economists – to reach for another metaphor – provided the intellectual justification the debt orgy that preceded the crash, so dietician’s line that sweetie snacks were fine as part of a “healthy balanced diet” contributed to a social environment that guaranteed a metabolic slump. So far neither profession has taken the rap.

At the conference there was no sense of any of this. Interventions to reduce the risk of diabetes usually relied on individual weight loss and low fat diet. There were high technical presentations about the effects of different kinds of fats with cautious conclusions that this might be slightly better than that. There was nothing you could build a program from. And there was a ghost at this feast – sugar. I only heard it mentioned once and that was as an acceptable part of a healthy balanced diet.

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