Obesity Is the Main Contributor to Diabetes in Blacks and Whites

What's more cost effective, Bariatric surgery OR treating years of diabetes and often severe complications??? This surgery has been greatly advanced and studied in the last ten years. I believe it is still very much underutilized. Insurance Companies: pay now, or pay more later. Not to mention the greatly improved health and LIFE of most patients. No, I'm not obese enough to have the surgery. But, I absolutely would, if allowed to do so. It actually works, and works well. Most diabetic patients have blood sugar control when leaving the Hospital, Post-Op. amazing.

Exposure to environmental chemicals is likely a causative factor, and related to the other risk factors (poverty, obesity, etc.) See this new research: https://www.medscape.com/viewarticle/889393

Black people live in food deserts. Access to fresh produce is almost completely unavailable. This affects us across the class spectrum because of residential segregation.

This article doesn't mention causation. How have the researchers determined that obesity causes diabetes? I have read that some researchers in the field that obesity is a symptom of diabetes, not a cause. If this study merely proves that obesity coincides with diabetes, their conclusion is not evidence-based.

The contortions people will go through to explain excessive weight. No, sugar and "carbs" do not cause insulin resistance, diabetes or obesity. Eating too much and moving too little are responsible for the vast majority of cases of excess body fat, and as a result of that, Type II diabetes. And no, Americans did not stop eating meat and other "naturally satiating foods." We never went low fat either, and are eating as much fat as ever. One thing that did change is energy balance. Inexpensive, readily-available, easy to prepare, tasty (fat+ sugar + salt) food; changing cultural norms; and lack of physical activity are the reasons. Nothing terribly exciting, no conspiracies, and no evil villains to blame - other than the junk food industry. But we've always known junk food was bad news, right? Popcorn time.

How do you keep your job?

If what is being offered patients is not working, then think of some other actions. Diet is a failure for many patients, like myself. And has been for 15 years. But I am still told to do it. And it is still not working. If diabetes is such a problemn, which we all know it is, then offer some new therapies. There is huge amounts of money to be made. And if the new trearments carry a much higher risk, then talk to your patients about the risk then. Let them decide. If you end up prescribing a drug that has issues like being a controlled drug, go ahead and prescribe it then. So if you think a short course of adderall is warranted, go ahead. A jump start so to speak. The cost saving could be enormous to society and healthcare. If I apy out of pocket 100% for mu insulin it woulkd be $1020 a month. With insurance I pay about $40. Now try to explain that to me. I know obesity is the cause of muy metabolic syndrome. The reason qwe are not changing the plan of action, billions of dollars are at stake. It is all about the money.

Or, is diabetes the main contributor to obesity? Read the work by Jason Fung, Gary Taubes, Tim Noakes, etc. Insulin resistance and hyperinsulimia make it very difficult for individuals to lose weight - their bodies continue to store fat, even while they starve in other ways. Fasting plus very low carb-high fat diets are effective at changing this pattern. It's time to stop basically blaming patients for their own gluttony when in fact they are victims of a metabolic disease caused by a high-sugar high-carbohydrate diet.

A strategy to achieve change is not as complicated as you think. A safe and effective dietary approach was approved as a qualified health claim by the FDA in 2016. (https://resistantstarchresearch.com/posts/fda-announces-health-claim-for... One of the trials considered specifically called out the impact on African-American women. Dr. Barbara Gower and her team at the University of Alabama at Birmingham found that resistant starch significantly improved insulin sensitivity in insulin resistant women. (http://dx.doi.org/10.1186/s12986-016-0062-5). While the study included a wide variety of women, all of the African-American participants were insulin resistant. Turns out that resistant starch's fermentation in the large intestine shifts the expression of genes that control the whole body's insulin sensitivity. Adding this one specific type of dietary fiber improved insulin resistance - a common biomarker underlying both type 2 diabetes as well as obesity. Before processed foods, people ate 30-50 grams of resistant starch/day. After processed foods, people eat about 5 grams of resistant starch/day.

OK so how do you lose weight when dieting doesn't work....when my mother died she was still able to gain weight on 800 cal/day....

And yet, physicians do not discuss bariatric surgery with their patients as a way to end the obesity cycle, which would reduce the diabetes (and elevated blood pressure and cholesterol.) And health insurers won't cover bariatric surgery, even though, my educated guess is that the cost of one surgical procedure could be saved in one or two years if it gets someone completely off diabetes medication.

Over the course of 25 years, 504 people out of 4251 developed Type 2 diabetes. That's a 12% "risk" for the total population. If black males had a 67% greater probability, that may raise the risk to 20%, depending on whether the comparison is to white males, all males, or all subjects . The study confusingly compiles relative risks and thereby conceals actual risk. The "risk factors" adjusted for were vague things like "diet, neighborhood, socioeconomic, psychosocial" etc. When "adjusted for", the racial disparity vanished. The suggestion that these elements can be externally adjusted in a manner that reduces the actual long-term rate of acquisition of diabetes seems highly premature. Maybe someone should help scientists learn a better way to present data, and a clearer way to present conclusions.

Obesity and diabetes are both closely correlated to carbohydrate/sugar consumption. Those types of foods are plentiful and cheap whereas healthy high protein and high fat foods are less so. Of course, when it comes to fats and oils, the better ones are also more expensive... cold pressed coconut oil and extra virgin olive oil. Since blacks have a higher proportion of their population in the lower economic ranges, they would be more prone to eating a less healthy, cheaper diet. Even those blacks who have move to higher economic groups may carry with them the cooking and eating styles of their families who ate the carbohydrate loaded diet. Fix the diet and the obesity is fixed and the diabetes disappears.

Nicholas, Nicholas, Nicholas. How many times do Commenters have to scold you—or the headline writer—that an association is NOT necessarily causation? It could just as easily go the other way: that diabetes (or metabolic disease) is the main contributor to obesity. (Read, for example, Gary Taubes. And that a high refined- carb diet is what leads to the original metabolism problems...) A big belly does not cause diabetes, but diabetes causes a big belly. This blurb somehow miss the whole point of the study conclusions. It is not about obesity or modifiable risk factors being causal. Such a study could not prove that. As the authors write in their “key points,” it is, instead, that: “After adjustment for biological, neighborhood, psychosocial, socioeconomic, and behavioral factors during young adulthood, the disparity [in eventual diabetes rates between blacks and whites] was no longer statistically significant.” See https://jamanetwork.com/journals/jama/article-abstract/2667072. In other words, there is nothing genetic (or racial) about American blacks higher diabetes rates.

I totally agree with this article. After I gained weight for several reasons, I tested pre-diabetic. I am now trying to reverse it with exercise and weight loss. This is a more effective approach than a change in diet.

Or does the diabetes cause the obesity?

Cause and effect is reversed here. The underlying insulin dysfunction that causes T2DM also causes obesity.

I was diagnosed with type 2 Diabetes and put on Metformin on June 26th, 2016. I started the ADA diet and followed it 100% for a few weeks and could not get my blood sugar to go below 140. Finally I began to panic and called my doctor, he told me to get used to it. He said I would be on metformin my whole life and eventually insulin. At that point i knew something wasn't right and began to do lots of research. Then I found Lisa’s diabetes story http://mydiabetesday.com/i-finally-reversed-my-diabetes/ I read that article from end to end because everything the writer was saying made absolute sense. I started the diet that day and the next morning my blood sugar was down to 100 and now i have a fasting blood sugar between Mid 70's and the 80's. My doctor took me off the metformin after just three week of being on this lifestyle change. I have lost over 30 pounds and 6+ inches around my waist in a month. The truth is we can get off the drugs and help myself by trying natural methods

Wow, and all these years we've been discussing not only obesity but also genetics in developing T2DM. For the record, I was never even close to being obese, though I was overweight for a time. I kept urging my doctors to run an A1C test (in addition to the fasting blood glucose test—which is relatively worthless in the grand scheme of things), but none ever would until last August. I even began taking metformin as a preventative. When my new doctor told me he had run the A1C test (9.5—ykes), I wasn't surprised. I was just surprised it had taken so long to be diagnosed. My father, mother, and both sisters were diagnosed and I was already prepared to take on the disease. My first test reading after that day was 528; now it's usually under 80. I told the doctor we were going to treat this disease aggressively. You don't really die from diabetes, but the complications will kill you. My readings today are generally in the low 80s or so after four months of treatment with double the dose of metformin and going directly to insulin (those pills? forget them; I worked on many of them and I know they aren't part of an aggressive treatment plan). I dropped 25 pounds as well. I feel like I'm making progress, but I also feel the disease is genetic. I had no options; it was going to happen sooner or later. But 528 to 83 in four months? That wasn't inevitable—it was hard work. (BTW, I know plenty of morbidly obese people who've never developed T2DM).