Diabetes: A modern-day killer

An estimated 422 million adults were living with diabetes in 2014, compared to 108 million in 1980. The prevalence of diabetes in the adult population has nearly doubled since 1980 rising from 4.7 percent to 8.5 percent, as per a World Health Organization (WHO) report.

The report highlights that the instances of diabetes have risen faster in low and middle-income countries.

South-East Asia and Western Pacific regions accounted for almost half all diabetes cases in the world. The WHO Eastern Mediterranean Region has seen the greatest rise in prevalence of the disease, reaching 13.7 percent of the adult population.

Forty percent of this increase is estimated to result from population growth and ageing, 28 percent is due to rise in age-specific prevalence, and 32 percent from the interaction of these two, says the WHO report.

The report adds that diabetes is not just a health issue but also puts pressure on the economy. It imposes a large economic burden on the global healthcare system and the wider global economy. This burden can be measured through direct medical costs, indirect costs associated with productivity loss, premature mortality and the negative impact of diabetes on nations’ gross domestic product (GDP).

The study shows that diabetes will lead to worldwide losses worth US $1.7 trillion from 2011 to 2030. This includes direct and indirect costs of diabetes, of which $900 billion will be incurred by high-income countries and $800 billion by low- and middle-income countries.

While the disease can be conquered by simple routine measures like a regular physical activity that reduces the risk of diabetes and increases glucose levels.

Global physical inactivity is of increasing concern. As per the report, latest data trends show that less than a quarter of all individuals above 18 years did not meet the minimum recommendation for physical activity per week. Data also shows that women, worldwide, are less active than men, with 27 percent of women and 20 percent of men classified as insufficiently physically active. Physical inactivity is also alarmingly common among adolescents, with 84 percent of girls and 78 percent of boys not meeting minimum requirements. Physical inactivity is the highest in high-income countries where it is almost double that of low-income countries.

Experts suggest that high sugar consumption through sugar-sweetened beverages (SSB) (aerated and non-aerated) can be associated with increasing risk of diabetes in children and its early onset among adults.

“The free sugars from sugar-sweetened beverages are the main concern linking obesity which itself is a major risk factor for diabetes,” says V Mohan, chairman and chief of diabetology at Dr Mohan’s Diabetes Specialities Centre, Chennai.

According to a study by the International Diabetes Federation, the number of diabetics has increased from 32.7 million in 2000 to 65.1 million in 2013. Data also shows that India, with 11 million diabetes-related deaths in 2013, was among four major countries to report the highest number of deaths due to the disease.

“The relationship between increased consumption of SSBs and its linkages with diabetes is more robust in children, and sometimes in adults. Cases of diabetes have increased by leaps and bounds in last ten years and some association can be ascribed between excessive SSB consumption and youth-onset obesity, metabolic syndrome and diabetes,” says Anoop Misra, chairperson, Fortis C-DOC, Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology.

How much sugar do SSBs contain? Sample this. Even the small packs of these beverages can significantly exhaust the recommended daily allowance (RDA) limit of 30g for sugar as per National Institute of Nutrition (NIN). Below is the review of some popular SSBs with the amount of sugars consumed from small individual packs and its comparison with %RDA value.

The data above shows that such sugary drinks can significantly contribute to the RDA of sugars and leave no or little room for sugars from any other food source. Indians already have a carbohydrate-rich diet and as per the WHO’s sugar guidelines, the daily intake of sugars across different populations should be less than 25g.

There is a lack of data on the per capita consumption of SSBs in India, but with the rapid growth of the beverage industry in the country, immediate interventions are needed to quell the risk of diabetes. “Data shows that the rising consumption of sugar in India parallels the diabetes epidemic as well as the obesity epidemic. We should certainly adopt measures taken in other countries before it is too late,” adds Mohan.

Mexico had the highest per capita consumption (135 litres) of carbonated soft drinks in the world in 2013. The country ranks near the top when it comes to adult obesity, first in Type 2 diabetes, and fourth in childhood obesity. To bring the situation under control, Mexico has introduced a sugar tax and revised nutrition labels to enhance consumer awareness as key public health interventions.

Easy availability of such drinks in urban areas and their growing penetration in rural areas can be held responsible for the rise in consumption. SSB sales in India increased at a rate of 7 percent per annum in 2015. Along with easy access, such products are also low-priced as compared to fresh foods such as fruits and fresh juices. Beverage companies such as Coca-Cola India, Pepsico India and Parle Agro have been launching smaller individual packs to increase the consumption of their beverage products.

Aggressive marketing and promotion of such drinks targeted at children and youth are also responsible for increased consumption. Most beverage drinks are endorsed by celebrities and some offer free goodies with the packs too. Experts say children are not the best judges of their food choices and get lured by such visuals and offers which can impact their choice and influence their parents’ decisions. “Advertisements for high sugar foods, especially SSBs, are designed to create a feeling of deprivation amongst observers which gets translated into cravings for the food. Free goodies and celebrity endorsements further reinforces the feeling which leads to an increase in demand amongst children,” says Pulkit Sharma, clinical psychologist and director at Imago, Centre for Self in New Delhi.

While India lags behind when it comes to having robust regulations for such advertisements on different media platforms, several countries have adopted measures to regulate product promotion targeted at children. For instance, they prohibit advertisements for such products during prime time or children’s programmes and restrict free gifts and toys. These countries include the UK, Canada (Quebec), Sweden, Estonia, Chile, Mexico, Iran and South Korea. 

Apart from advertisements and promotion, appropriate nutrition labelling of foods is an important factor. “Nutritional labelling in our country is still not adequate and is often misleading as consumer awareness has still not increased to the levels reached in Europe or in the US,” says Mohan.

Current food labels are inconsistent across different variants and different packaging of the same product category. It also varies across different product categories. Key gaps include the absence of RDA values and per serve information on food labels. These labels do not declare salt content in foods and include information for 100 g of product. Internationally, most countries mandate the declaration of salt on product labels. RDA values and per serve information are also included. In India, there is no provision for the front of pack (FoP) labels to provide nutrition information at a glance to help consumers make informed dietary decisions. Some brands declare this information on voluntary basis albeit inconsistently. There are no initiatives yet for providing warning labels on foods in India to highlight any negative aspects.

“There is a need to regulate marketing and promotion of sugary foods. There is also a need for psychoeducation of parents as their choice gets influenced by food advertisements. Instead of promotion of sugary foods, the government should promote options such as fresh fruits,” suggests Sharma.

(The views expressed are solely those of Down to Earth)