Type 2 diabetes is called a “lifestyle disease” because it can be caused by poor eating habits. But this label doesn’t account for the fact that genetics play a role too, nor that nutritious food is unaffordable for many people in SA, writes Bridget McNulty for the Bhekisisa Centre for Health Journalism.
Tekkies*, a sheep shearer in his mid-60s, is patiently waiting in front of a low-cost supermarket in the Eastern Cape town of Jansenville. He didn’t move here by choice. His family was forced to relocate in the early days of SA’s democracy because the farm they had lived and worked on in the rural Eastern Cape was turned into a game lodge.
With the move came a profound change in his diet.
Farm life meant a package of food delivered weekly as part of his pay. That benefit was gone. He couldn’t grow anything either because he didn’t have any land. Plus, work was often scarce, so his wages didn’t always go far enough to buy fresh food.
Processed food was cheaper, so Tekkies relied on that.
A few years after moving to Jansenville, he was diagnosed with type 2 diabetes, a condition many experts call a “lifestyle disease” – but Tekkies didn’t choose his lifestyle; it was forced on him.
The silent killer
Diabetes affects how well your body can control the amount of glucose is in the blood. Your body is supposed to take the blood sugars from broken-down food into cells as energy. But the bodies of people with type 2 diabetes have stopped responding well enough to the hormone insulin, which makes this trip into cells possible, so the energy never gets to their cells and their blood sugar stays high. The condition, most common among older adults, can lead to blindness, heart problems and nerve damage resulting often in amputation.
Alongside genes in some cases, the type and amount of food you eat can also increase the chances of developing the condition.
Red meat, fried and processed food and sugar are bad news. Eating fruits and vegetables, on the other hand, can help prevent diabetes,
In SA, the number of people with type 2 diabetes is escalating. Official diagnoses of the condition shot up from 4.5% in 2010 to 12.7% in 2019 – tripling in just nine years. That’s probably an undercount. New research suggests that about 8% of people in SA who have diabetes don’t know about it.
Tekkies’ diabetes diagnosis may not have been directly caused by moving to Jansenville. He was getting older, and may have been at risk of developing diabetes for a while. Possibly, he was only diagnosed in town because he had better access to a clinic. Perhaps he has the genetic wiring to make him more likely to develop diabetes in the first place.
Still, his story holds important lessons that should inform how we think about so-called lifestyle diseases such as diabetes.
Most people in SA don’t choose cheap food because they don’t care about their health. Exercise isn’t that simple either – particularly for women living in unsafe areas.
Though diabetes is a non-communicable disease (NCD), some of the factors that make people more likely to develop diabetes are, in fact, communicable, meaning it can spread from one person to another.
While diabetes doesn’t spread from one person to the next in the same way a virus does, the circumstances that contribute to diabetes certainly have a “communicable” social aspect to them.
People in the same household probably eat similar foods based on how much money there is, and family traditions and preferences also influence your diet. This could put people in the same household at a similar risk of developing diabetes.
Defeating diabetes: What’s the plan?
SA has a new action plan to fight NCDs including diabetes, heart disease, mental illness, lung diseases and cancer.
By 2027, 90% of adults should know whether they have high blood pressure or high blood sugar: 60% of people who know they have high blood pressure or blood sugar will be treated.
And half of people who are treated for hypertension or raised blood sugar will have their condition under control.
These are worthy targets – particularly as they are the first diabetes targets SA has ever set. But I worry we’ll struggle to reach them without changing how we treat the people this plan is designed to help.
We need to stop playing the blame and shame game when it comes to type 2 diabetes.
I have been running SA’s largest online diabetes community, Sweet Life, for 11 years. I have seen first-hand that people who feel supported and understood are far more likely to make positive changes in their lives – that’s what true empowerment looks like.
People aren’t inspired to change if they feel judged and sidelined.
How about as a first step, we stop calling diabetes a lifestyle disease? Then, we change the messaging to say that everyone should be eating healthier food and exercising a little each day.
*Tekkes – not his real name.
Bridget McNulty is the co-founder of Sweet Life, SA’s largest online diabetes community, and has been living with Type 1 diabetes for 14 years. She is also a published author and co-founded the Diabetes Alliance and SA Diabetes Advocacy.
National Strategic Plan for 2022-2027 (Open access)
NCDs-NSP-SA-2022-2027-1
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Fruit but not fruit juice to lower type 2 diabetes risk — AusDiab study
SA’s sugar tax pits jobs against lifestyle diseases
Lifestyle changes effective in high-risk pre-diabetes
A multidisciplinary approach is key to treatment of type 2 diabetes