HYANNIS – When endocrinologist Evan M. Klass, MD, FACP, went into the specialty 40 years ago, he imagined spending his career treating thyroid problems, fixing pituitary glands and helping with fertility issues. But these days he’s mostly focused on one problem: diabetes.
Americans, he said, are making ourselves sick from the calorie-dense and high-sugar foods that we eat, and we need to change our diets, exercise more and slim down.
“I went from not being a diabetes doctor to being a diabetes doctor, purely because of obesity,” he said.
In the United States, more than 70 percent of adults over the age of 20 are considered overweight and 40 percent are considered clinically obese, according to the National Institutes of Health. That’s based on body-mass index, a tool that’s a ratio between a person’s height and weight. While BMI isn’t the only factor doctors consider when determining healthy weight, it can be an indicator and a screening tool, experts say. These days, it’s more like an alarm bell.
“Mostly the reason we need this many endocrinologists is because of changes in the level of obesity,” Dr. Klass said. “This is a societal problem and it requires a huge investment to change the entire environment in which people live.”
He isn’t the only one seeing a problem with the quality of our diet and how it promotes Type 2 diabetes and cardiovascular disease, among other problems. In a recent opinion piece in The New York Times, the dean of the Tufts University Friedman School of Nutrition Science and Policy and a former secretary of agriculture together argued that one of the best ways to control healthcare costs is to create financial incentives for Americans to improve their diets. This might include offering prescription programs for healthy produce and, for the sickest patients, reimbursing for home-delivered healthy meals.
On the Cape, there are efforts to turn things around through education and nutrition counseling, some of it available at little or no cost. For example, on Nov. 14, World Diabetes Day, the YMCA Cape Cod will sponsor information sessions about diabetes presented by Cape Cod Healthcare experts and others. The event, from 11 a.m. to 2 p.m., at the YMCA in West Barnstable is free. And that’s just a small part of what’s available.
What’s So Bad About Obesity?
Obesity is believed to trigger changes to the body’s metabolism and has been directly linked to the development of diabetes. Patients with Type 2 diabetes have abnormally high blood sugar levels and their bodies stop using and making insulin properly.
While we might think of diabetes as an endocrine disorder, it affects many more of the body’s systems. Elevated blood sugars and accompanying inflammation have a detrimental effect on the vascular lining and the arteries, said Matthew Tooker, a nurse practitioner with the cardiology service at Cape Cod Hospital. A patient with diabetes without any sign of heart disease is at the same level of cardiovascular risk as someone who’s had a heart attack but is not diabetic, he said.
Heart issues can be sneaky for diabetics, Tooker said. Diabetic patients may come to the emergency room with symptoms such as neuropathy or body aches, but still have the changes in heart function or elevations in cardiac enzymes that indicate heart injury.
“So the muscles and the arteries and the nerve endings are all responsive to that elevated blood sugar,” said Tooker. “That’s why tight control of diabetes is so important.”
While some medications and medical conditions, such as hypothyroidism, can be a factor in obesity, for most people issues with weight center on their diet, researchers say. Americans eat too much sodium, sugar and red meat, according to research by the Tufts nutrition center, and not enough nuts, whole grains, fruits, vegetables, seafood-based omega 3 fats and polyunsaturated fats. Tufts recommends what’s called a Mediterranean-style diet, rich in olive oil, lean proteins, and fruits and vegetables.
“When I talk to patients about cardiovascular disease and their diet, I tell them to look at their dinner plate in quarters,” said Tooker. “Two of the quarters should be green, leafy vegetables. A quarter should be grains, things like rice, beans, legumes, things like that. Then the other quarter, or the last quarter, should be protein.”
But eating healthy isn’t always easy or economical.
“Good foods tend to be more expensive,” Dr. Klass said. “That’s why poorer people consume less of them. We have all kinds of people on the Cape, living at all income levels. We have affluent retirees who can buy whatever they want. But I see people in my practice for whom food insecurity is a real issue.”
And older people who live alone – particularly men – may choose to eat out, get take-out, or grab something from the frozen food section, said Tooker. “It’s tough, because chances are, he’s never cooked a meal before in his life. It’s just that generation; they go to the store and they buy a dozen Swanson dinners, and they’re loaded with salt. They’re not a balanced diet but they are easy.”
Help Making Changes
Clinicians at Cape Cod Healthcare refer patients to diabetes education and nutrition counseling. And there are other resources available in the community, some at little or no cost.
For example, the Diabetes Education Center at the YMCA in West Barnstable is available to the public during any hours that the Y is open, said Janet Buckley, the Y’s chronic disease program coordinator. The center has books, periodicals, computer stations and flyers with information about all types of diabetes and healthy eating, she said. The Y also offers free training to people who need to use blood-sugar monitors.
The “coolest part,” Buckley said, is that the program’s nutritionist, Lauren Kunkler, offers five free one-hour nutritional counseling sessions to any diabetic – Y member or not. All that’s required is an appointment.
“The really great thing about Lauren is that she really gets to know the person and works with them about lifestyle changes that actually will work for them,” Buckley said.
The Y also has a program for people who have been diagnosed as prediabetic – meaning their blood sugar levels are borderline. It meets once a week for the first four months, then every other week, and then once a month, Buckley said. It works on diet and exercise. For now, the Y charges $429, which includes a Y one-year membership. Eventually, the Y hopes the program will be reimbursable by Medicare.
“The focus is to prevent diabetes,” Buckley said. “It’s not a diet. It’s a lifestyle-change program that’s meant to encourage people and work with people to get them to make changes in their lifestyle, primarily by losing a little bit of weight, and also by increasing their exercise to about 150 minutes a week.”
Another initiative, Prescribe the Y, is just being rolled out, Buckley said. It offers a 12-week membership for $150 to anyone who wants to work on a specific health goal: lowering blood sugar or blood pressure, controlling weight or increasing socialization.
Anyone interested in the programs at the Y should contact Buckley, 508-362-6500, ext. 136, or [email protected].
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