Beat it

Beat it

Addressing Type 2 Diabetes: An Immodest Proposal

Could this “warning label” on sugary sodas help curb the devastating consequences of Type 2 diabetes?


When the CDC confirmed a patient had been diagnosed with Ebola on American soil in late September, the nation saw just how quickly U.S. officials, physicians and hospitals can respond to a serious public health threat.
Through a highly coordinated effort, 35 hospitals across the nation aggressively prepared to screen, identify, isolate and treat patients with the devastating disease caused by the Ebola virus.
The speed of response was impressive, perhaps even enough to raise the hope that we as a nation could stamp out any public health crisis with the right level of concern, coordination and funding.
Experience tells us otherwise.
Every smoker knows that cigarettes can cause cancer, yet they smoke in spite of the Surgeon General’s warning (and their doctor’s warning, and warnings from just about everyone else).
Likewise, people with Type 2 diabetes know what to do. They just don’t. As a result, this growing threat is already the seventh leading cause of death in the United States. Most often caused by poor diet, excessive calorie intake, lack of exercise and obesity, diabetes affects an estimated 29.1 million Americans and costs our nation up to $69 billion in medical bills, disability, work loss and premature death.

One in three Americans today are pre-diabetic and 1.7 million new patients are diagnosed each year with diabetes. Despite new medicines and medical advances, diabetes is poorly controlled in about 25 percent of patients across the U.S.
You might assume these statistics would serve as a powerful “call to action” for behavior change but you’d be wrong.

Although diabetes can lead to cardiovascular disease, kidney failure, blindness and even amputation of toes, feet and legs – a procedure 200 U.S. patients undergo every day – we have not been able to get most people to change their behavior.
Understanding the growing diabetes problem, its causes and the lack of action is complex.
Behavioral science research demonstrates that when a threat isn’t immediate, people are slow to respond. When heart disease and amputation are years or even decades down the road, both doctors and patients tend to be complacent. And since initial therapy includes pills to reduce blood sugar, people often feel as though they’re doing enough to treat their problem, even if they ignore diet and exercise recommendations from their doctors.
Taking or prescribing a pill requires minimal effort. It’s not until patients are forced to prick their fingers, check their blood sugar and inject insulin that many realize the significance of their problem. By then, it can be too late to reverse the damage done to their blood vessels and nerves.

Even physicians are starting to take a fatalistic view on diabetes as their patients fail to adopt a healthy exercise regimen and diet. The conversation around starting insulin is a difficult and time consuming one. So, sometimes doctors hold off telling patients the time has come. Instead, they choose to add more pills in the hope blood tests will come back better the next time. Too frequently they do not.
Both patients and physicians are frustrated by how difficult it is to reverse lifestyle habits contributing to Type 2 diabetes and its complications.
As a result, doctors perform 73,000 lower extremity amputations a year. And many patients with diabetes require a series of amputations, beginning with a toe and progressing to the entire foot and lower leg.
Perhaps it’s time to turn this gruesome and growing consequence into something a bit more “real” for those at risk.
Consider this “immodest proposal” as part of a bigger solution: Imagine if every high-fat, calorie-dense food package contained photos of lower-limb infections and amputations as a “warning label.”
This may seem like a far-fetched idea, but the Federal Drug Administration (FDA) tried something similar with cigarettes until the tobacco industry won a legal battle.
Perhaps times are changing. This year, the city of Berkeley, California passed an ordinance taxing soda sales. And just a couple of years ago, the famous Bloomberg big-soda ban in New York made it all the way to the state’s highest court.
Could shock-tactics with revolting images of amputated parts on soda containers and fast-food packaging work, or at least make people lose their appetites?
We know reducing the average person’s sugar intake and helping them achieve a more normal weight can help prevent Type 2 diabetes.
Maybe seeing people without feet and legs on sugary soda containers could change youth behavior so that teenage Type 2 diabetes might once again become rare (today about 20 percent of teens with diabetes have Type 2).
And maybe these same images would shock patients who’ve already developed diabetes into exercising more often, managing their weight better or improving their diets.
Using amputation as the poster child for change is gruesome and revolting, but it may be the only solution that will work. So far, nothing else has.
Dr. Robert Pearl is the CEO of The Permanente Medical Group, a certified plastic and reconstructive surgeon, and Stanford University professor. Follow him on Twitter: @RobertPearlMD.