By Andrea Pedroza-Tobias, MS, PhD Candidate
After graduating from college, I volunteered as a dietitian at a public hospital in Mexico that serves low-income populations. I remember seeing kids and their parents in the waiting room drinking soda at 7 am. Most of the patients I saw had diabetes. I initially started offering nutrition plans for their disease, but very often got the same response: "I can't afford food." I began to feel hopeless and frustrated knowing that I was not helping my patients. Having experienced food insecurity myself, I knew that giving nutrition counseling was not enough. How can you tell a patient to buy healthy food when they struggle to pay rent and afford medicine?
That's when I realized the health and food system were broken. As a health care provider, I had learned to see the patient as the only driver of change, asking them to make lifestyle modifications as if they were the only one responsible for their health. Now I know that taking individual responsibility doesn't work well when there are no food and health policies that protect individuals' health and wellbeing in the unhealthy food environments in which we live.
We can't ask people to stop drinking soda when it is the only beverage on sale, and there is no free and safe drinking water. We can't ask kids and their parents to avoid eating junk food when kids are targeted by unfair and deceptive marketing from the food industry. We can't ask a patient to eat healthy food and ignore that patients have to make difficult decisions about whether to buy insulin or food.
We can’t have healthy food environments when the junk food industry has the ability to influence health policies. We all agree that tobacco companies shouldn’t fund studies evaluating the association between smoking and lung cancer, because that represents a conflict of interest. Then, why do junk food and beverage companies fund studies evaluating health policies aimed at preventing obesity and diabetes? Why do junk food and beverage companies have political influence in global health governance? To truly see a difference, nutrition policies should be designed without industry interference, prioritizing changes in the food environment.
Diabetes has killed 6.7 million people globally just this year. Every 5 seconds, one person dies as the result of diabetes. The number of new diabetes cases has increased dramatically in the past decades. For example, the U.S. went from 217 annual cases per 100,000 people in 1999, to 380 in 2019. You might wonder, why doesn't the world take diabetes seriously? Well, the UN's Sustainable Development Goals do include "reduc[ing] by one-third premature mortality from non-communicable diseases" by 2030. Yet, we seem far from meeting the target, especially in low- and middle-income countries.
If you wonder what can you can do, here is a list of things that we, as a society, can do to prevent new cases of diabetes:
- If you are a student/researcher, educate yourself about conflict of interest. Avoid receiving funding from the food industry or other organizations if that represents a conflict of interest. We have seen that one of the food industry’s main tactics is to pay researchers to create industry-friendly evidence that they can use to prevent or delay health policies.
- Support health policies that enable a healthy food environment, such as:
- Front-of-package food labeling. Chile implemented front-of-package warning labels consisting of a black octagon that indicates whether a product is high in added sugar, saturated fat, sodium or calories. Recently, Mexico adopted this approach and added a legend for products children should avoid because they contain caffeine or non-nutritive sweeteners.
- Restriction of advertising for unhealthy foods aimed at children. Chile banned marketing that targets children through any communication channels, including graphics on food packages and advertisements on television and websites.
- Access to healthy food. One example is the Healthy Beverage Initiative implemented at UCSF that eliminated the sales of sugar-sweetened beverages on all campuses. The "Food is medicine” movement provides medically-tailored meals and groceries or food prescriptions to patients with diabetes and other health conditions.
- Fiscal policies. Mexico was the first country that implemented a nationwide soda and junk food tax, which has now been implemented in 35 other countries and 8 US cities.
- Demand a healthy food environment. For example, you can ask your hospital/school/workplace to remove sales and advertising of junk food and sugar-sweetened beverages. Ask policymakers in your county/city/state/country to not include the food industry in the hearings and negotiations of health policies.
- Volunteer or donate. You can donate to organizations that are fighting against this epidemic, such as those affiliated with the “food is medicine” movement that provide medically-tailored meals to low-income people living with diabetes and other health conditions. If you live in the Bay Area, you can donate/volunteer to Project Open Hand.
- Eat healthy food, drink plain water, and avoid sugary beverages. A single 12-oz. can of soda contains almost 10 teaspoons of added sugar – more than the American Heart Association recommends as the upper daily limit.
Diabetes is a serious disease that represents a health and economic burden for the individual and the health system in all countries. Fortunately, the food environment is modifiable, and I have hope that we, as a society, can make a change by demanding healthy food environments and health policies that protect our most vulnerable populations.