Stigma versus support: The gruesome countdown to a global epidemic

It’s National Obesity Week, and it seems everyone has an opinion on diabetes – politicians, activists and policy makers. The marriage of diabetes and lifestyle is endlessly examined, alongside dire warnings about what it’s costing.

As more people develop it, the stigma of diabetes intensifies in public consciousness because it’s rarely mentioned without its apocalyptic spouse, obesity.

In the drive to prove cause and effect, more complex issues and some of the inconvenient facts fall by the wayside because a scare story is easier to run with.

And that’s how, it seems, finger pointing at the obese has become the norm – under cover of the message that diabetes is preventable. The trouble is, stigma sends people into hiding when they need support. Add race and class to the mix and the pressures on individuals intensify even further.


Two distinct conditions

The point is, there are many layers of fact and context – including the difference between Type 1 and Type 2 diabetes.

First of all, Type 1 is an autoimmune condition. It’s most likely to be diagnosed in children and young people between the ages 9 and 14 and there’s currently no cure.

About 10% of all adults with diabetes have Type 1 and they have to take insulin every day of their lives, by injection or pump.

Yes, Type 2 diabetes is preventable, but with lifestyle changes which seem to run counter to all the trends shaping modern diet. How do individuals, sometimes financially stretched, resist the food industry’s money makers: cheap processed food made appealing with sugar and salt and carbonated drinks, while the cost of fresh fruit and vegetables rises?


Fighting a global market

Global brands and supermarkets with enormous advertising power dominate a market that the US Department of Agriculture estimates is worth $4 trillion (£3.7 trillion) a year. But packaged food alone is expected to rise in value to $3.3 trillion (£2.62 trillion) by 2020 according to Research and Markets, a Dublin-based market research company.

So the majority of people with diabetes (85%-95%) have Type 2 and it’s becoming more common in children, adolescents and young people of all ethnicities but South Asian and African/Caribbean people are two to four times more likely to develop it.

In 2016, when data analysis company Exasol looked at six years of prescriptions for diabetes medication, the highest prescribing areas were in London and the East Midlands. It was no coincidence that these areas also have a substantial BME (black and minority ethnic) population.

But in a gruesome countdown, we learn the number of people in the UK with the disease has now gone past the four million mark, a kind of deadly threshold, with thousands more undiagnosed…and the accompanying message is – it’s costing millions because of all the amputations and associated problems.

Globally, we learn hundreds of millions of people are at the tipping point and we’re experiencing an epidemic of pre-diabetes.


Support not shame

Who’d put their head above the parapet? Who’d be heard asking what they can do about it amid the clamour of blame? I call it the blame and shame disease, a small study in Australia, found 84% of people who took part believed they had been stigmatised by having Type 2 diabetes. They felt blamed, stereotyped, discriminated against. And the stigma came from the media, healthcare professionals, friends, family and workmates. So they didn’t want to talk about their condition – making it far harder to seek help and support for change.

So who’s calculating how better intervention, in the form of support to lose weight and exercise, could offset some of these feelings and the associated costs of so many people with type 2? The NHS has developed really good online resources that include a Couch to 5k running plan, 12 week fitness plan and weight loss plan.

Maybe it is time for a new look at prevention and treatment of Type 2 diabetes?

Published on: January 11, 2017