The Other, Unexpected Type 2 DemographicFriday, August 02, 2013
Diabetes educator Janice Baker RD, CDE, CNSC, is seeing well-educated, affluent people with abundant resources heading towards pre-diabetes and type 2 diabetes. Not only are these people going in this direction by engaging in unhealthy lifestyle behaviors, their teenage kids are following a similar path.
By: John Parkinson, Clinical Content Coordinator, DiabetesCare.net
A common belief is that people who come from a lower socioeconomic status are being diagnosed with type 2 more than other groups. This may be partially true, but what is equally distressing is what Janice Baker is witnessing. In her practice as well as her consulting work, Baker (pictured, lower right) is seeing well-educated, affluent people who are also at risk of or already have type 2 diabetes.
She points out these people have the resources to take advantage of having good health, yet many are not doing so. They have good insurance coverage to see medical providers, can purchase healthy food, and buy gym memberships or have trainers.
Baker works in a large multi-specialty medical group, Arch Health Partners, and does consulting work through her own business, Baker Nutrition, for some large companies in the San Diego, Calif., area. She sees engineers as an interesting demographic and a good example of a microcosm of this present-day conundrum. She points out that engineers often work in sedentary positions, are under a tremendous amount of stress, eat out or eat the unhealthy catered food their companies supply. And they don’t exercise.
Possibly worst of all, their kids are following in their footsteps and applying similarly bad lifestyle habits.
She has also done volunteer work at the local schools talking about nutrition and seeing and hearing first-hand what and how kids are handling their diets. Generally speaking, she is seeing the younger generation acting like their parents.
Baker likes to call it the “new normal,” where people including younger generations believe they are destined for type 2 diabetes.
She is also concerned from a personal perspective because she has two sons who are engineering majors in college, so this really hits home for Baker.
She is also quick to point out these companies are offering comprehensive health benefits including onsite corporate wellness programs, and so it’s there for the taking but there aren’t many people who are using them.
The question then remains for these people who are not taking advantage of such corporate wellness programs, what will motivate them to do so?
Possibly one of the things that could combat this and awake the malaise of people is awareness about potential complications these people may face. One of the consequences of seeing larger numbers of people with type 2, according to Baker, is witnessing an increasing number of people who are getting diabetes-related kidney disease.
Baker teaches a local kidney disease class, and she says people are blind-sided by the diagnosis as they are not aware of this type 2 complication and understanding why they are getting it. Many are progressing to kidney dialysis quickly, and she points to her local Veterans Administration (VA) medical center and how the VA is now outsourcing dialysis treatment as proof of large numbers of people who are getting this complication. In most cases, Baker says the antidote for all this potentially progressing diabetes and kidney disease is making sensible adjustments to diet and having people start moving.
DiabetesCare.net recently sat down with Baker to discuss what she is seeing, how she treats patients and clients, and her insights on changing the course for our type 2 diabetes epidemic.
DiabetesCare.net: In terms of socioeconomics, you are working with affluent clients, who have resources, and very good educational backgrounds, but they are also very unhealthy and progressing towards pre-diabetes and type 2. Can you talk about what it is that is causing this?
Baker: Yes, they have all those things, yet it is a stressful, competitive environment they work in. Their jobs are sedentary, and they have a tendency to eat out a lot. They become wrapped up in their careers and they sometimes put off getting screened for health issues.
Because of the nature of these jobs, they are going to be more apt to have diabetes earlier in life.
I have two sons who are engineering majors in colleges and they are working in these fields during the summer. And these types of companies not only have good medical plans, but they have incredible wellness programs on the company campus. They have medical health education, and they are encouraging their employees to participate. I’m impressed by their efforts.
Still, thus far, it’s a personal decision. Companies can offer these programs, but they can only do so much because it’s up to the individual.
DiabetesCare.net: Do you think it’s the nature of how we do business that everything is so fast-paced that fast food or already prepared foods have a tendency to be the food of choice?
Baker: Yes. When you go to any grocery store, you see all these premade foods, like chicken or lasagna dishes for example, that might have a lot of fat and sodium injected into them, but people don’t want to pay attention to the potentially unhealthy aspects of these premade meals.
People are tired, and they want something that tastes good, takes a minimal amount of time to make, and doesn’t take much to clean-up. It takes a lot of work to make a lasagna from scratch. Unfortunately, what that encourages is consumption of more fat and salt, because that’s what sells.
DiabetesCare.net: In terms of nutrition, what is the biggest problem you are seeing? Overconsumption of calories? Eating the wrong foods?
Baker: It’s a combination of the two, and it’s the fact that people aren’t moving. It’s not complicated. We overanalyze things too much. We really need to simplify this. There are a lot of agendas out there that make it more complicated than it needs to be.
Don’t tell me it is something in the food or it’s something in the water bottle. I’m not saying there is nothing to those claims, but people don’t want to look at what they are doing. They are often denying what they are doing is unhealthy.
It’s the new normal. The way we eat, the lack of movement, and the way our bodies look. People are accepting this as their destiny, which I think is really sad. I’m seeing people in their 30s who already have health issues that I didn’t used to see until people were in their 60s.
We are putting people on statins and blood pressure medicines at such young ages. This is part of the new normal. They don’t think they are different and when people don’t feel like they are different than the norm, they are not apt to do anything about it.
DiabetesCare.net: You are working as consultant in a wellness program. Can you talk about what you are doing specifically for the wellness program?
Baker: I work in corporate wellness, as well as contracting out through other companies that provide worksite wellness programs. They are mostly large companies in the San Diego area.
You get a glimpse of what is going on in other peoples’ lives and how their jobs may be impacting their health.
DiabetesCare.net: Is there anything specific you are seeing with the teens?
Baker: They do what their parents do. They aren’t going to listen to their parents; they are going to watch their parents. Teens need good role models, and that is our responsibility as parents. These teens in these situations are going to see this and say, ‘that’s my destiny and what happens when you get older.’ I don’t blame them. They don’t have the maturity yet or can analyze this appropriately.
DiabetesCare.net: What is the biggest co-morbidity of type 2 diabetes you are seeing locally?
Baker: Within the patient population I’m working with, I’m seeing an increase in diabetes-related kidney disease.
DiabetesCare.net: Can you describe the condition of these patients with renal disease and the quality of life these patients have?
Baker: It starts off a lot like type 2 diabetes. It`s very vague in how it presents. Often patients don’t understand what is going on with their kidney disease until it is in a later stage. There is a lack of awareness.
I teach a general class on kidney disease and caring for it. I get people from all over who attend this class. People are upset when they find out they have stage 2 or stage 3 kidney disease and they want to know why they didn’t know about this sooner.
DiabetesCare.net: Do you feel like we are just going to continue to see a large incidence of type 2 diabetes in these populations. What is going to be the tipping point?
Baker: Yes, and I don’t know. People have to decide personally what they are willing to do, and a lot of people don’t act until there is true discomfort and pain. In these chronic diseases, there is a need for personal responsibility. People need to be willing to accept they have to change their lifestyle habits.
DiabetesCare.net: It was a slow transformative drumbeat, but government public health initiatives we had in the 1970s through the 1990s helped turn the tide with cigarette smoking. Do you think this should be applied to the obesity/type 2 epidemic?
Baker: Perhaps in some ways awareness helps, but the fact is food is legal and it’s inexpensive, so it makes it challenging to change peoples’ behaviors. We are not bothering anyone when we are drinking a soda.
This is just my view point, but I think this will be seen in other areas in the U.S. of people within the same socioeconomic status. People have the freedom to do what they want, and I don’t want to take that away, but I want to make sure people have their eyes open to the choices they make.
As medical providers, we are not here to dictate what people should do. I ask them what they want to work on and what it is they want to do—what is realistic for them.
I don’t give out meal plans; I work with them to see what they are doing and what their life is like, and when making changes I want to be as minimally invasive as possible, so they will stick with them. Strict diet plans can often turn peoples’ worlds upside down. They think it’s the answer, but it’s never going to be. A plan has to be something durable and realistic in the long haul.
Perhaps a public initiative could help. It’s good that there is awareness and a discussion about this pressing problem, but we also need people to act as well.
For anyone interested in contacting Baker for her services, people can go here.