Once considered a 'western' disease, diabetes has become an increasingly a global problem. The International Diabetes Federation predicts that the number of individuals with the disease will increase from 240 million in 2007 to 380 million by 2025. An estimated 60% of those cases will be in Asia. In North America and Europe the disease most often hits people in their 60s and 70s, but in Asia, it is increasingly hitting the young and middle aged. Asia's diabetics are also thinner: Reviewing 20 years of research on diabetes in Asia, the study's authors, scientists Frank Hu of Harvard's School of Public Health and Juliana Chan of the Chinese University of Hong Kong, found that in Asian populations the risk of diabetes starts at a lower Body Mass Index, or BMI, a measure calculated by dividing weight in kilograms by height in meters squared. (See "Five Truths About Health Care in America.")
In Asia, as elsewhere, weight still does matter; obesity and diabetes are clearly linked. The problem, the study found, is that measures of obesity are one-size-fits-all. People with a BMI above 25 are generally considered "overweight," and those with a score above 30 are labeled "obese" and therefore generally considered more at risk for the disease. But focusing on fat alone misses a chunk of Asia's epidemic, says Hu. "BMI doesn't tell the whole story."
Reviewing over 200 studies on diabetes in Asia, researchers looked at a host of socio-political and cultural shifts that have changed the way Asian people live and eat. The twin processes of rapid economic development and urbanization are partly to blame, says Chan. Changes that took place over 200 years in Europe have been accelerated in Asia, leading to what she describes as a "mismatch" between people's genetic make-up and their habits. Food is more abundant today across Asia than it was, say, 100 years ago, but bodies have yet to adapt. Says Chan: "We are five foot three, but we eat like we are six feet tall." (Read "Gastric Bypass May Be Less For Helpful for Diabetics.")
Though packing six feet worth of food into a five-foot frame is never advisable, it may be particularly dangerous for Asians, the study found. Because of the metabolic mismatch Chan describes, some people may lack the cells to store excess fat. Instead of bunching around the buttocks or amassing on the arm, extra fat builds in other places, like the liver. Many Asian people, particularly South Asians, are also more prone to abdominal obesity, the study noted. Skinny people with thick middles are particularly prone to developing Type II Diabetes, which helps explain why the disease is spreading in places where people are, on average, quite thin.
The cost is huge. Type II diabetes is linked to a host of illnesses including heart disease, stroke and kidney failure. The World Health Organization predicts these diabetes-linked chronic diseases will cost China alone about $558 billion in lost productivity and healthcare costs over the next decade, taking a large bite out of the country's hard-fought economic gains. And so it is across the continent unless things change. Professor Hu is cautiously optimistic. The good news, he says, is that Type II Diabetes can be controlled with prevention and treatment. He hopes the study will convince policy-makers to spend big on both. That's a pricey proposition, to be sure. But then again, health is a pretty good investment.