​Why is so little progress being made in slowing down the dramatic rise in obesity and Type-2 Diabetes around the world? Why is this exploding diabetes crisis akin to watching a huge global train wreck in slow motion? Every country that’s been invaded by the standard overly-processed Western Diet is ‘enjoying’ rising levels of obesity and type-2 diabetes. Highly westernized islands in the Pacific lead the inter-related obesity and diabetes charts, with enclaves like Kuwait and the Bahamas not far behind. The U.S. is the first large country on the list, leading in percentage terms, followed by New Zealand, Canada and Australia with the UK close behind. The witty comment that ‘diabetes is caused by speaking English’ might have had some relevance ten years ago, though in absolute numbers, China and India now dominate.  ​​​As they play catch-up with their increasingly westernized food and lifestyles, the situation is predicted to go from bad to worse. Yet mainstream views continue to be divided about the underlying causes.

The global diabetes crisis - like watching a slow-motion train crash, with no way to stop it. ​ This guest post is written by an expert in the field of consumer communications: James Capon  ​

Taken from IDF 2015 report

Confusion reigns

You have to feel for the confused 'Man or Woman on the Street' when it comes to diets, diabetes and obesity. Information can be so divisive and confusing that it’s often just easier to be a cynic, claiming that next week’s advice will be different... and yet, in doing so, you avoid taking any personal responsibility. At the time of writing, mainstream health authorities continue to push a low-fat message, and although sugar has morphed into today’s public enemy number one, most diabetic patients are told that other refined carbs, particularly when combined with artificial sweeteners, are perfectly acceptable.

"You're seriously asking me why I'm so confused?"

Popular press: a mouthpiece for whoever feeds them information.

​Diabetes support groups working within the guidelines of national health authorities have chosen to push the 'low-fat' and  ‘bad sugar’ messages above all else. Because of this, you can still observe global ‘westernized’ citizens in coffee bars and cafes around the world devouring their blood sugar stimulating sandwiches in the mistaken belief that it's the butter and ham which will make them ill, rather than the mass-produced bread that surrounds it. All the while, food industry lobbyists push extreme stories at the tabloid newspapers whose readers now consider frequently changing and contradictory headlines simply to be the norm. They prefer us to remain confused and cynical, as they continue to muddy the waters.

In a world of alt-facts, we still trust our doctor

In an attempt to unify and amplify these low-carb messages and promote real food, the Public Health Collaboration PHCUK was founded in 2015 aiming to: “improve the healthy eating and weight loss guidelines currently given by the NHS” - particularly for pre-diabetics and diabetics. Less than two years old, the PHCUK is off to a great start but contradictory mainstream messages from official sounding sources like WebMD or the Mayo Clinic which still state that carbohydrates should be your major source of energy add to the general confusion. In addition, studies using a low-carb definition of 10% of consumed calories may contradict other research which says that 40% can already bring large improvements – or it may be the opposite!! And so on. In the press, relative weight, food density and calorific impact get mixed up in discussions featuring numerous 'industry   experts' ; in supermarkets, daily calorific percentage values found on labeling make things even more confusing for the lay person. And let's not forget the views of our much-maligned nutrition/dietitian community who tend to push the “we’re all different” or “no one diet fits all” message and… true confusion reigns.

One of the excellent PHCUK lower-carb Real Food booklets. Source: Dr David Unwin & PHCUK. Click to expand

Confuse them and you'll lose them

Keep it simple stupid (KISS)

From tacit agreement to conviction

Communications Summary If you are one of the many who would like to help reduce the spread of Type-2 Diabetes among those eating Westernized diets today - and that's almost the entire world now:  Let’s simplify messaging. Let’s agree that Type-2 Diabetes is primarily a disease of carbohydrate intolerance. Let’s put aside the quibbling and communicate straightforwardly that a disease which is caused by eating too many carbohydrates can only be ameliorated, and even reversed, by eating fewer carbohydrates. It’s as simple as that.

Tell it like it is: this food represents the pathway to Type-2 diabetes - it's full of starchy, sugary carbs.

Ultra-processed food(2): formulations of several ingredients which, besides salt, sugar, oils and fats, include food substances not used in culinary preparations, in particular, flavours, colours, sweeteners, emulsifiers and other additives used to imitate sensorial qualities of unprocessed or minimally processed foods and their culinary preparations or to disguise undesirable qualities of the final product. 

​SYNOPSIS The public debate about junk food usually comes down to a damning indictment of all foods high in calories and rich in ‘high fat, salt and sugar’, whatever type of food you find them in. The informed debate is more nuanced and often singles out the role played by sugar, whilst adding in other refined carbohydrates, cheap vegetable seed oils and food additives.      Often an emotional topic, the quality of the debate has been recently enhanced thanks to a changed stance from the UN at the start of their Decade of Nutrition, when a food grouping known as ‘ultra-processed’ foods came sharply into focus. So are all ultra-processed foods by definition the same as junk food? And would it help if that were the case? Click here for the full 15 minute read.

The Big Read

If you know what junk food is, you can make informed choices

​        Public opinion about junk food leaves much to the imagination and brings with it confusing contradictions. In Ireland, councils desperately trying to do the right thing when it comes to childhood obesity, issue ‘no-fry zones’ which can allow a Starbucks to set up shop near a school, while banning the Fish & Chip shop – perhaps the original fast-food outlet. In New York, whole milk gets banned in schools while low-fat chocolate flavoured milk is permitted… not to mention that the school authorities now refer to whole milk as ‘full-fat’ milk.         Meanwhile, manufacturers tweak their recipes for processed foods such as sausage rolls in the UK, so that the well-meaning traffic light labelling system shows them in a good light (no pun intended). By reducing the meat content and substituting margarine for the butter or lard originally used in the flaky pastry, they can even position them as a healthy snack. Yet logic tells me that they are a form of junk food.

A singular feature of NOVA is its identification of ultra-processed food and drink products. These are not modified foods, but formulations mostly of cheap industrial sources of dietary energy and nutrients plus additives, using a series of processes (hence 'ultra-processed'). All together, they are energy-dense, high in unhealthy types of fat, refined starches, free sugars and salt, and poor sources of protein, dietary fibre and micronutrients. Ultra-processed products are made to be hyper-palatable and attractive, with long shelf-life, and able to be consumed anywhere, any time. Their formulation, presentation and marketing often promote overconsumption.
Studies based on NOVA show that ultra-processed products now dominate the food supplies of various high-income countries and are increasingly pervasive in lower-middle- and upper-middle-income countries.

​It’s now almost 10 years ago since Ben Goldacre coined the phrase Nutritionism and referred to it as the "bollocks du jour" in a famous article for the New Statesman. He was, notably, referring primarily to self-styled media nutritionists, those who often find themselves quoted in the tabloids, but two quite separate events in this past week sum up the damage that nutritionism has already done and continues to exacerbate in our own Western food culture. These two events were namely the American launch announcement of a specially packaged cow’s milk marketed at kids by Coca Cola, and the far-away decision by a remote group of Pacific Islands to turn their back on junk food. ​ Putting aside the difficulties of reaching agreement on a definition for junk food, what the Vanuatu Islanders have effectively done is rejected a part of Western culture that inevitably seems to lead to chronic diseases such as obesity and diabetes wherever it is introduced. This is namely, the packaged and processed food so typical of our culture and driven by the need for extended shelf life and increasingly competitive supply chains.

The 'Superkids' version of Fairlife's new lactose-free, low-fat milk product.

The remote Vanuatu Islands of the South Pacific

​Now consider how, at roughly the same time as Coca Cola announced their new packaging, the Torba province of Vanuatu, representing a group of Pacific Islanders having just 10,000 inhabitants made the decision to impose restrictions on the import of Western foodstuffs. “It is easy to boil noodles or rice, but they have almost no nutritional value and there is no need to eat imported food when we have so much local food grown organically on our islands.” Said Father Luc Dini, head of the local tourism council. ​With the backing of local chiefs Dini has ordered tourism bungalows to serve guests only locally grown, organic food and inhabitants will set aside rice, sweets and biscuits, aiming to become Vanatu’s first organic province by 2020.

For reference: the 10 most obese places in the world

"Our genes load the gun, but it's our environment that pulls the trigger"