By Sheri Colberg, PhD
In updating a chapter on exercise and diabetes for the American College of Sports Medicine, I came across a recently published article about the benefits of lifestyle modification for diabetes prevention. In this study by Djoussé and colleagues at the Brigham and Women’s Hospital and Harvard Medical School1, the objective was to examine the association between modifiable lifestyle factors, including diet, exercise, weight loss, smoking abstinence, and moderate alcohol consumption, and residual lifetime risk of diabetes.
They followed 20,915 men (1982-2008) and 36,594 women (1992-2008) with a mean age at baseline of 53.5 and 54.6 years, respectively, by ascertaining their modifiable lifestyle factors and adiposity at baseline and incident diabetes during follow up.
During an average follow up of 22.6 years in men and 13.0 years in women, 2,096 men and 2,390 women developed diabetes. At age 45 years, the residual lifetime risk of diabetes for men with 0, 1, 2, 3, and 4 + healthy lifestyle factors was calculated as 30.5, 21.5, 15.1, 10.3, or 7.3 percent (decreasing with the increasing number of healthy lifestyle factors). Corresponding values for women were 31.4, 24.1, 14.2, 11.6, and 6.4 percent, respectively. The authors concluded that these data show an inverse and graded relation between desirable lifestyle factors and residual lifetime risk of diabetes. Moreover, not smoking and engaging in moderate drinking had additional benefits when added to exercise, weight control, and diet.
You have to ask yourself: is this truly new information? Maybe the association between moderate drinking and lower diabetes risk is less well known, but it is still known2, as is the relationship between smoking abstinence and lower risk3,4. A study published the month before the one by Djoussé reported almost exactly the same results, except that it also found that when lifestyle improvements are made in combination to put people in the "low risk" group, results did not differ by family history of diabetes or level of adiposity5.
Essentially, then, we have known how beneficial lifestyle interventions are in preventing diabetes for quite some time, starting from before6 the publication of the landmark Diabetes Prevention Program almost a decade ago. That realization leads me to wonder why it is that we are failing to take this information to heart and implement it effectively across our nation.
It appears that we have a culture of overweight and obesity in the United States. We all know we need to lose a few pounds, but so does everyone else we know, so why worry about it? It is more acceptable these days to be overweight than to be normal weight (unless you’re a movie star, of course). I would venture to say that we have evolved into a culture of reverse discrimination, whereby the normal weight people are pressured by others to partake in the office doughnuts and have trouble finding clothes that fit in mall shopping stores (the main department stores only carry down to a women’s size 4 now, in most cases).
The problem really resides, I believe, in our own behaviors and attitudes. By way of example, I recently traveled to a state in the heartland of America to give an invited lecture about why exercise is the best medicine for diabetes management and prevention, and I was appalled to see the physical state of the 300+ health care professionals attending the day-long, state-sponsored diabetes conference. Not only were the vast majority of them overweight or obese (even morbidly so), but also almost all of them that I observed enjoyed a sugary, very diabetes-unfriendly dessert with their lunch after sitting around all morning long. While I have to applaud the fresh fruit offered in the center of every table in the conference hall, the smorgasbord of pastries, cookies, and pies was still the focus of everyone’s attention. I even heard one (overweight) diabetes educator remark that the pumpkin pie looked so good that she just had to have a piece before she left, even though she also said that she knew she should not eat it.
If we cannot manage to follow the lifestyle that we know prevents diabetes, what good will telling our patients what they should be doing do? Lead by example.
- Djoussé L, Driver JA, Gaziano JM, Buring JE, Lee IM. Association between modifiable lifestyle factors and residual lifetime risk of diabetes. Nutr Metab Cardiovasc Dis. 2011 Oct 5. [Epub ahead of print]
- Joosten MM, Grobbee DE, van der A DL, Verschuren WM, Hendriks HF, Beulens JW. Combined effect of alcohol consumption and lifestyle behaviors on risk of type 2 diabetes. Am J Clin Nutr. 2010 Jun;91(6):1777-83.
- Davey Smith G, Bracha Y, Svendsen KH, Neaton JD, Haffner SM, Kuller LH; Multiple Risk Factor Intervention Trial Research Group. Incidence of type 2 diabetes in the randomized multiple risk factor intervention trial. Ann Intern Med. 2005 Mar 1;142(5):313-22.
- Patja K, Jousilahti P, Hu G, Valle T, Qiao Q, Tuomilehto J. Effects of smoking, obesity and physical activity on the risk of type 2 diabetes in middle-aged Finnish men and women. J Intern Med. 2005 Oct;258(4):356-62.
- Reis JP, Loria CM, Sorlie PD, Park Y, Hollenbeck A, Schatzkin A. Lifestyle factors and risk for new-onset diabetes: a population-based cohort study. Ann Intern Med. 2011 Sep 6;155(5):292-9.
- Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, Willett WC. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001 Sep 13;345(11):790-7.
Sign up for the Diabetes "Fit Brain, Fit Body!" fitness/lifestyle programs or for 5 free Healthy Living Reports at www.lifelongexercise.com, and access more articles and information at www.shericolberg.com. If you need tips for getting safely started on an exercise program, check out The 7 Step Diabetes Fitness Plan. For people with any type of diabetes who are already more active, consult the Diabetic Athlete’s Handbook.