T2D: the longest mile: type 2 diabetes--the leading cause of blindness, kidney failure, and lower limb amputation, as well as one of the major risk factors for heart attack and stroke--now strikes every third person born in this country.

• Author: Draznin, Boris
• Position: Medicine & Health

A WEEK PASSES by without a story concerning the epidemic of obesity and Type 2 diabetes. T2D is the most common form of diabetes, frequently associated with excess weight and insulin resistance (inadequate action of insulin). This epidemic is real and frightening. It is estimated that the riskof developing Type 2 diabetes for individuals born in the year 2000 (our children and grandchildren) is 32.8% for men and 38.5% for women. The fact that every third person in this country will go on to develop T2D in his or her lifetime is staggering.

The magnitude of the impact of T2D on individual health and societal health care resources is enormous. The annual direct and indirect cost of diabetes care is about $150,000,1300,000. In addition to being the leading cause of blindness, kidney failure, and lower limb amputation, it has emerged as one of the major risk factors for heart attack and stroke, robbing people, on average, of 12 to 15 years of life.

At the same time, a number of clinical trials has demonstrated convincingly that T2D can be prevented. Surprisingly for many, the most powerful prevention is achieved with lifestyle changes. Up to 60% of people who otherwise would have developed diabetes were able to prevent it by modifying their lifestyle. The old adage about "an ounce of prevention" goes far beyond its true wisdom when applied to T2D. Because 90% of people who are going to develop it are overweight and somewhat sedentary, the two main components in the lifestyle change are weight loss and activity. Sounds simple, but it is extremely difficult to do. The sheer number of books offering "a quick and simple" weight loss recipe is a sure sign that the problem is much more complex than these books imply. Otherwise, the situation would have been resolved a long time ago.

A survey conducted by Consumer Reports of the efficacy of various diets reveals that only three percent of the people in the survey had managed to complete formal weight-loss programs. Among those who had finished, the average success rate was 26%. Overall, 95% of those who lose weight on any diet regain it within the next 12 to 24 months. Not surprisingly, most people give up, as frustration and denial replace drive and perseverance.

How do we, practically speaking, lose weight, become more active, and prevent T2D? Of course, some things are beyond our control. For instance, Type 2 diabetes has a very strong genetic component. If one parent has it, the chances of a child...