The economics of 'diabesity'

The worldwide trend for the past few decades is characterized by expansion of the middle class-something that we in the United States consider to be a positive development.

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But the middle class, according to a recent 70-page report by the multinational bank Morgan Stanley, is expanding in more ways than one.¹

“Higher income leads to a higher rate of sugar consumption and more sedentary life,” reports Carmen Nuzzo, a European economist who co-authored the report.

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Per capita sugar consumption has climbed nearly fivefold over the past century to 53 pounds per year. A huge chunk of humanity finds itself, for the first time, with the income necessary to purchase sweet foods and beverages. As American diets have spread around the world-and pizza has replaced fresh fruits and vegetables as the preferred comestible for teenagers worldwide-a condition known as “diabesity” has become endemic.

According to the report, some 387 million persons have diabetes, and the emerging markets of the world are disproportionately impacted. Forty percent of patients with diabetes live in China and India, and in many countries, the disease will slow economic growth as diabetic workers lose productivity.

Even in the United States, with our remarkable medical infrastructure, lost productivity from diabetes in 2012 is calculated at $69 billion.²

Next: High cost of care

The cost of care for the average patient with diabetes is about $8,000 per year. With diabetic retinopathy being the most common cause of vision loss in working-age Americans, that cost only skyrockets when people don’t come to see ophthalmologists for their annual screenings and disease is allowed to progress to an advanced stage.

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According to Morgan Stanley, diabetes and obesity are slowing economic growth in the world. In the United States, the Organization for Economic Cooperation and Development projects the 2.5% annual growth for the next 20 years will fall to 1.8% as the bodies of U.S. workers-marinating in glucose-accomplish less and fail earlier than those of their less-wealthy-but-healthier parents.

Our species evolved to survive seasons of plenty (harvest time) and seasons of hunger (winter). We cannot handle our newfound middle class-ness and the 24/7/365 availability of food.

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The report gives an interesting analysis of the damage caused by “diabesity” by country. I find it difficult to understand the common threads among the losers and “winners” in this sad story.

The greatest danger to growth rates is in Chile, the Czech Republic, Mexico, the United States, and Australia. France, Japan, and Switzerland are the least-affected countries. The Czech Republic (really bad) is a relative stone’s throw on a map of Europe from France (good) and Switzerland (really good).

What, exactly, do these people in the latter countries know that the rest do not? How can this be effectively transferred?

It is time to get serious about this about this problem.

Next: But what to do?

When former New York Mayor Michael Bloomberg tried to ban large servings of soda a few years ago, the courts struck down his ordinances in favor of freedom of choice. At a minimum, we ophthalmologists should do everything in our power to encourage, cajole, and beg our diabetic countrymen-and the physicians monitoring their disease-to get into our offices for their examinations.

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At the same time, we should eliminate any and all barriers to access for these folks when they do call to schedule.

References

• The price of sweetness. Barron’s. March 30, 2015, p 17.

• http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html