Celebrity chef Paula Deen announced yesterday that she has Type 2 diabetes and she is getting paid to pitch a diabetes drug, but she’s also become the reluctant poster woman for what NOT to do to avoid diabetes. News stations have been running footage of her on the Food Network delicately wrapping macaroni and cheese with raw slices of bacon or unveiling a cheeseburger using a doughnut as the bun, while predicting an end to her best-selling cookbooks.
All we have to do is connect the dots from doughnuts and bacon to diabetes, right? Actually, experts believe that the road to Type 2 diabetes is largely paved through extra weight and an unfortunate set of genes. If it runs in your family and you’re overweight, you may be bound to get it even if you feast on brown rice, grilled salmon, and Greek yogurt.
“There have never been any good studies showing that the kind of foods people eat leads to diabetes in the long run,” said Richard Kahn, a diabetes researcher at the University of North Carolina and former executive director of the American Diabetes Association. “But we do know from studies that overweight individuals who lose at least 4 percent of their body weight can delay the onset of the disease.”
Judging from photos, Deen is overweight, perhaps even obese. She said she’s had diabetes for three years but feels no qualms about continuing to push greasy comfort foods; as she told NBC’s “Today” show, “I’ve always said, ‘Practice moderation, y’all.’ I’ll probably say that a little louder now.”
Kahn caused his own stir last week at a diabetes conference when he presented a paper published in the journal Health Affairs stating that efforts to establish community-based intervention programs “will not be very effective in preventing diabetes, largely because most overweight or obese people cannot maintain weight loss over time.” He said money would be better spent on diagnosing diabetes early and managing it with medications.
Joslin Diabetes Center in Boston -- which has an ongoing 18-year study evaluating whether diabetes can be prevented through exercise and weight loss counseling -- issued a press release sharply attacking Kahn and saying Joslin physicians strongly disagreed with his comments.
The release included this heated quote from Dr. Osama Hamdy, medical director of Joslin’s obesity clinical program: “Saying that physicians should stand by and allow patients to proceed to a diagnosis of diabetes is a disservice to patients and constitutes a surrender in the face of one of the greatest threats to public health the world faces today.”
Kahn told me that Hamdy’s quote “greatly distorts the issue” by implying that he’s saying individual patients with insulin resistance -- which often precedes diabetes -- should make no attempt to lose weight. Those who are motivated to slim down, he said, should certainly try working with their doctor or joining a gym or diet program like Weight Watchers. He’s questioning whether government funds should be used to provide free or subsidized programs to overweight populations in, say, community health centers.
(Kahn serves on a heart disease advisory committee to Novo Nordisk, which manufactures the diabetes drug, liraglutide.)
While intervention studies usually lead to weight loss over the first year, Kahn said study participants always gain back the weight over subsequent years. “They can delay diabetes for a few years, but it doesn’t prevent it, and we don’t know if that protects them against long-term complications of the disease.”
Joslin diabetes prevention researcher Dr. Edward Horton, a past president of the American Diabetes Association, said in an interview that weight re-gain over time is a reality in studies -- even when researchers make every attempt to help participants maintain the loss with diet and exercise counseling.
Still, participants in the diabetes prevention trial that Horton’s been leading for 18 years weigh, on average, a few pounds less than they did when they entered the trial years earlier and the only support they get is twice yearly meetings urging them to stay on track. What’s more, Horton added, about 5 percent of them wind up gettting diagnosed with diabetes every year compared with a rate of 11 percent that was initially measured in the control group.
“Richard Kahn is a dear friend of mine,” Horton said, “and I think he got the facts right in his paper, but he’s a pessimist, and I’m an optimist.” While Kahn has his doubts, Horton said he believes prevention programs will save health care costs in the long run and delay or prevent heart disease and other complications of diabetes -- which studies still need to verify. Another paper from federal researchers published in the same issue of Health Affairs projected $5.7 billion in health care savings over 25 years if a community diabetes prevention program was implemented nationwide.
“The question isn’t whether these prevention programs work,” added Horton, “but whether they’ll work in the real world and not in a research setting. Kahn is telling people who fund prevention programs not to bother and only fund research to find and treat diabetes effectively. We feel strongly that you have to do both.”
What both can agree on: The ultimate solution for our nation’s ballooning rate of diabetes will rest on finding an effective solution to the obesity crisis to keep the majority of Americans -- including celebrities like Paula Deen -- from becoming overweight in the first place.