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Public Health: Diabetes isn’t worth the weight



By Erin A. Bills, MPH, Public Health Columnist

Worldwide, the prevalence of both adult and childhood obesity has dramatically increased in the last 20 years. In the U.S. it’s become an epidemic.

This is caused by an improvement in socioeconomic conditions and the growth of the modern world: with it comes an increase in high fructose corn syrup, dietary fat, alcohol consumption, and a decline in physical activity.

The global and national statistics are mirrored in Montana. The prevalence of overweight and obese adults here is slightly lower than the national average but is increasing at the same rate. This has resulted in an increase in obesity-related diseases like type 2 diabetes.

In Montana, diabetes affects 53,600 adults, or 7 percent of the adult population. According to the Montana Diabetes Project, type 2 contributes to 90-95 percent of the diabetes disease burden. Diabetes is the leading cause of kidney failure, non-traumatic lower-extremity amputations, and blindness among adults, according to the Centers for Disease Control and Prevention. The incidence of type 2 diabetes varies slightly between Gallatin, Madison, and Park counties ranging from 4-7%, which is consistent with national trends.

Diabetes is a chronic metabolic disorder that affects how the body uses glucose (sugar), which is the body’s main energy source. In a healthy, non-diabetic individual, glucose from food enters the bloodstream, the pancreas secretes a hormone called insulin, and the insulin helps guide the glucose out of the bloodstream and into your body’s cells providing needed energy. For diabetics, the disrupted production of insulin or resistance to the effect of insulin results in high blood sugar levels.

There are two types of diabetes: type 1 and type 2. Both disrupt blood sugar regulation. Type 1 is an autoimmune disease that inhibits production of insulin; this form is not preventable. Type 2 diabetes is a result of the body developing resistance to insulin; type 2 diabetes is preventable and is directly linked to being overweight or obese. There are many health complications that are associated with diabetes. These include renal disease that can lead to kidney failure, peripheral neuropathy (a disturbance in skin sensation of the hands and feet) that can cause pain or lead to ulceration, eye disease that can blindness, and depression of the immune system that can increase the risk of infection. These are just a few of the health complications that are linked to diabetes.

Simple and small changes can significantly help manage type 2 diabetes and may also help prevent the disease for persons who do not have diabetes. These include losing weight, becoming more active and eating a healthy diet.

To reduce the burden of chronic diseases like type 2 diabetes, many health policy decisions need to be addressed and implemented. Our schools could reduce the number of unhealthy snack choices in vending machines. Helping teens to establish healthy lifestyle choices at a young age has potential to reduce the risk of developing type 2 diabetes. Policy intended to improve access to health care in our rural communities can help prevent people with diabetes from developing complications of the disease such as kidney or heart disease. Preventing complications can significantly reduce the overall health care costs in all of Montana’s communities, and this is especially true for the rural regions of our state.

Implementation of a new patient based health promotion system focused on disease treatment would be equally valuable. Health promotion systems are more socially comprehensive than our current healthcare model. They work to address underlying causes of poor health, promote healthy lifestyle and reduce risk factors.

The Montana Diabetes Project, part of the Dept. of Public Health and Human Services, is a health promotion program that educates Montanans about diabetes. Based on creating patient centered care rather than disease centered care, the project focuses on patient interactions, organization of healthcare, community and policy.

With 145,552 square miles of land, Montana is one of the largest states in the nation. It’s also one of the most rural, with a population density of four to 12 people per square mile. Considering these factors, it’s easy to see why access to healthcare is difficult, and chronic diseases like type 2 diabetes is trending upwardly in our state. Directing educational resources to our rural populations is of essence in this battle of the bulge.

Erin A. Bills, MPH, works at Montana State University. She lives in Big Sky and is dedicated to improving the health of Montana’s rural populations. Follow her Blog at


Chronic diseases cause significant worldwide morbidity and mortality—in fact, the World Health Organization estimates they result in 60 percent of the 56 million annual deaths. This percentage is even higher in the U.S., where chronic diseases cause 70 percent of mortality. Cardiovascular disease, cancer, chronic respiratory disease and diabetes account for a large percentage of this.

In the past, communicable diseases caused a higher percentage of mortality. This shift is increasing in both the developed and developing world. Driving forces behind the transition include socioeconomic, political, cultural and lack of health interventions. Numerous epidemiological studies have linked development of chronic disease with risk factors like tobacco use, poor diet and lack of physical activity.

In a healthy, non-diabetic individual, glucose from food enters the bloodstream, the pancreas secretes a hormone called insulin, and the insulin helps guide the glucose out of the bloodstream and into your body’s cells providing needed energy. For diabetics, the disrupted production of insulin results in high blood sugar levels.

Are you at risk of developing a chronic disease like diabetes? Find out at and talk with your doctor today.

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