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Education vital to tackle obesity

More must be done: Dr Annabel Fountain says Bermuda’s diabetes problem is a strain on its economy

More must be done to address the growing issue of obesity and diabetes, according to local endocrinologist Annabel Fountain.

A recent study found that almost three-quarters of participants were overweight or obese, while 42 per cent of adults reported two or three chronic disease risk factors.

Reacting to the study, Dr Fountain noted that obesity has been directly linked to the onset of type two diabetes, along with hypertension, strokes, heart disease and a number of other health issues, and the impact is already being felt by the Island’s young people.

“The wards in the new Acute Care Wing are 25 to 40 per cent occupied by people with diabetes and their length of stay is at least double that of people without diabetes,” she said.

“The population in the hospital affected by diabetes is not the ‘old age’ group that we used to expect. It is not just affecting the retired population but our adults of the traditional ‘working age’.

“We have a very high prevalence of obesity in our young people. We know from global statistics that these individuals are at much higher risk of developing type two diabetes, and in Bermuda we have teens and young adults developing complications already due to type two diabetes.”

She said the increasing number of Bermudians being diagnosed with diabetes is already affecting the Island’s economy, noting the high cost of medication used to control diabetes and hypertension.

“Many individuals are struggling to afford them, as well as the cost of more frequent visits with healthcare professionals,” she said.

“Added to this, we have high rates of diabetes-related complications, which often result in disability, reducing the ability to work and often requiring government assistance.”

Dr Fountain said that steps can be taken to prevent the onset of diabetes, stressing the importance of educating the community.

“This starts as early as when a mother is pregnant,” she said. “Offspring of women who have diabetes in pregnancy have increased risk of diabetes later in life.

“Educating girls, pregnant women and women of child-bearing age, explaining the impact of lifestyle on their children would be helpful. We have all understood the impact of smoking or drinking alcohol in pregnancy — this is the same thing.”

While she said some patients don’t attend monitoring appointments because of cost concerns or out of reluctance to miss work, regular monitoring and interventions are effective in preventing costly complications and hospitalisations. I am pleased to see that the Standard Health Benefit that is being developed is going to encompass more preventive care and monitoring,” she said.

“The indirect cost of individuals not attending because their employers are not supportive is likely to be significant in the long-term.

“If individuals are able to attend for preventive care and therefore avoid the complications of diabetes and other chronic health conditions, overall costs will reduce. I would recommend that employers see the bigger picture and encourage their employees to attend their scheduled appointments.”

Dr Fountain also called for better reporting and monitoring of non-communicable diseases, along with improved coordination between healthcare practitioners.

“Blood tests and scans are being done in different facilities without information being accessible to all relevant parties,” she said. “This can lead to duplication, delays and added expense for the system.

“An electronic health record where all health information related to each individual is collected would eradicate these issues and also would allow for assessment of outcomes in the population through simple audit of data.”

Asked about the possibility of introducing a sugar tax — something that has been discussed by the Bermuda Diabetes Association and Kim Wilson, the Shadow Minister of Health — she said a similar strategy was shown to be effective in Mexico.

“Bottled water can be more expensive than sugary drinks — I think this is sometimes the case here,” she said. “However, it has now been established that sugar is an addictive substance — more so than heroin and cocaine.

“I have seen many individuals where this is clearly the problem, even those going blind or nearing dialysis, still not able to resist.

“Taxes were not that effective in reducing cigarette smoking. It was warning labels [outlining] the stigma of it when smoking was banned from public buildings that had the biggest impact on this.

“A tax on sugar may not have the desired impact if individuals are addicted to sugar but warning labels such as those on cigarettes and alcohol may be more effective, along with early education about the damaging effects of excess sugar on the body and our health.”