When I went to medical school, I was taught about two basic kinds of diabetes: juvenile onset and adult onset. From the time I did my training in medical school to the end of my residency we were already seeing the transformation of adult onset diabetes into Type II, which is what we call it now, which from my perspective is a euphemism we have draped over this condition to conceal the fact that what was a chronic disease in midlife is now epidemic in children. Frankly, Type II diabetes in a seven year old is adult onset diabetes. We just don't want to confront that unpleasant fact.
David KatzWe have literature indicating that overwhelmingly, health is influenced by a very short list of modifiable behaviors topped by three: tobacco use, physical activity and dietary pattern. You could modify those three things; you can change people's fate. I wanted to change those. Smoking cessation, important but relatively simple - a lot of people are working on that. Physical activity: important to me, important to health but also relatively simple. I like nutrition. It's complicated; you really need to learn a lot of stuff to be an expert there.
David KatzWe are creatures. We have a link with a native habitat just like every other species. Throughout most of human history, physical activity was unavoidable, calories were scarce and hard to get. In the modern era, calories are unavoidable, physical activity is scare and hard to get. The traits that allowed our ancestors to survive, and let's face it, the survival of our ancestors is the reason that we're here because the people who don't survive and make very crummy ancestors, are our traits. But they're very much at odds with the modern environment.
David KatzWe don't control everything. There are genetic influences. There are environmental exposures we don't control. I cannot guarantee anyone I counsel that by following what I hope is the good advice I offer them, they will live long and prosper. That's what I'm hoping for but I can't guarantee that. What I can tell them is this: "Look, I can help you firmly grip the wheel, and you can steer the ship. You're never going to control the winds and you're never going to control the seas. But if you sail well you can get through just about anything."
David KatzThere's an awful lot about our society that is at odds with the basic message of "don't smoke, be active, eat a healthy diet, and by the way control stress and get enough sleep." We don't make those things easy. We ideally would make health lie along the path of least resistance. But if not the path of least resistance, there at least needs to be a path so you don't have to bushwhack your way there.
David KatzMy view of chronic disease prevention of fighting epidemic obesity and diabetes, of turning the tide, is that it is the job of professionals to pave the way and to cultivate the will; to stir people up so that they understand the stakes, so that they recognize that adult onset diabetes stalking children is a clear and omnipresent danger. The wolves are at the door. You must defend hearth and home. And here are the means to do it: we must provide programs, policies, tools and resources so that everybody can do the job.
David Katz