In the report, UnitedHealth Group, headquartered in Minnetonka, Minn., recommends interventions based upon evidence that intensive lifestyle changes can prevent or delay the onset of diabetes. The landmark Diabetes Prevention Program, chaired by Dr. David M. Nathan, director of the diabetes center at Massachusetts General Hospital in Boston, demonstrated that overweight and obese people with pre-diabetes could reduce by 58 percent their risk of becoming diabetic with diet and exercise.
But despite those results, which appeared in 2002 in the New England Journal of Medicine, most people have proven themselves unwilling or unable to keep up the long-term with steps necessary to achieve these improvements.
Peters, an investigator in the federally funded Look AHEAD trial, a long-term study of weight loss and exercise on cardiovascular risks among overweight and obese diabetics, said it reinforces an intensive Diabetes Prevention Program-like model with social support. "We have parties and classes and individual sessions and group sessions; we have a lot of ways that we engage patients in their health."
The problem is that "people do lose weight, and will regain it once the intervention stops. Basically, everybody with diabetes needs a lifelong lifestyle coach. You need somebody to call you and bug you. You need a support group and a walking group."
And, mindful of Thanksgiving, she said, "You need not to be able to ignore it because it's the holidays."
The solution comes down to constant community outreach, Peters said. "If 50 percent either have diabetes or pre-diabetes, then the whole community needs to support this. There needs to be the mayor's office leading a walking collective; there needs to be a healthy dinner once a week at Town Hall.
She suggested that health care companies may be able to lead the way with incentives for good behavior, rather than penalties for bad habits.
Peters, who prides herself on being a lifelong exerciser, said even she can be motivated by the right incentives. Staffers at her East L.A. clinic decided that everyone should engage in two corporate walking challenges. "Every week we have to give our miles to our team captain. All of a sudden, I became a fanatic. It really drove me to exercise more when I might not have. The accountability totally motivated me." But even she noted that her enthusiasm dropped off once the competition ended.
The solution, she said, comes down to determining "how do we motivate each person?" And, more difficult, how the country finds the money to pay for that.