Health & Medical Diabetes

Socioecological Determinants of Prediabetes and T2DM

´╗┐Socioecological Determinants of Prediabetes and T2DM

Call to Action

To date, intervention for the prevention of diabetes has followed a medical model of identification of individuals at risk and enrollment of at-risk volunteers into one-on-one or small group intervention trials. It is essential to better understand how social and environmental variables influence behaviors that lead to obesity, prediabetes, and diabetes and to learn how to modify these variables to prevent and manage them. Research in this area remains associational in nature, but the amount of data linking these factors is substantial. Efforts aimed toward individual behavior change are difficult, with extensive data on the failure of weight loss programs and the compensatory biologic responses that promote weight regain. The extent to which the environment may limit the effectiveness of prior efforts to achieve weight loss and maintenance is unclear, but the associations noted above clearly point to a potential role for environmental interventions in the initial prevention of overweight and obesity.

The American Diabetes Association recognizes the association between social and environmental factors and the development of obesity and type 2 diabetes. To date, the medical model focused primarily on the individual has provided limited benefit in curbing the epidemics of obesity and type 2 diabetes. A public health approach to alter the environments in which we live, learn, and work in order to enable healthy behavior and healthy lifestyles and, therefore, to promote health and prevent disease may hold promise for making further progress against these epidemics.

This review provides a number of potential targets for intervention to prospectively evaluate the role of social and environmental factors in the development of obesity and diabetes. Only well-designed interventions that focus both on the individual and on the social and physical environment in which the individual lives will answer the question. Our failure to adequately address the growing epidemics of obesity and type 2 diabetes will soon overwhelm our health care system, and investment in targeted research toward these identified social and environmental factors appears to be a productive avenue to improve our nation's health.

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