South Asian Diabesity Prevention Initiative Taskforce (www.BIT.LY/SADPIT)

Diabetes+Obesity = Diabesity, which assumes a whole new dimension for 1.5 billion South Asians on this planet.

Diligently targeted work is needed to develop public health policies about South Asians that caters to their unique culture

The proposal for launching this entity aims to realize the vision of establishing a joint private public health promotion and disease prevention body in the Lower Mainland of British Columbia and draws upon by the following key documents:

1. Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 published on 17 December 2014 with an excerpted version published in Science Daily Life expectancy globally rose from 1994 to 2014 as death rates from 5 diseases fall and death rates from 5 diseases rise That is what the next job for humanity now becomes. [These emerging five novel killers are Alzheimer's Disease, Pancreatic Cancer, Kidney failure, Kidney cancers and Hypertensive Heart Disease or heart failure from high blood pressure; and are lifestyle linked.]

2. Global Burden of Disease Study 2017 by The Lancet

3. Diabesity A world-wide challenge published by the European Union in 2012

4. World report on ageing and health published by World Health Organization 2015

5. South Asian Health Report published by Fraser Health in 2016

6. Strategies to control childhood obesity and adult obesity among South Asians by Dr. Prashant Mathur and Dr. Rakesh Pillai in June 2019.

Prashant Mathur and Rakesh Pillai’s paper published in Indian Journal of Medical Research in June 2019; 149(6): 695–705 outlines the crisis of Overnutrition: Current scenario & combat strategies for South Asians and outlines the aspects of debates and obesity specific to South Asians.

Distal factors of nutritional imbalance or overnutrition among South Asians

1. Shortening of duration of breastfeeding of infants compared to the past decades

2. Ready availability of calorie dense foods at home,

3. Food or nutrition insecurity or unpredictability of availability.

4. High preference and increased consumption of sweet and fatty/fried foods

5. Increased consumption of salty snacks

6. Skipping meals especially breakfast with overcompensatory splurging,

7. Lower and declining physical activity (sedentary lifestyle)

8. Increasingly stressful environment at home.

9. Increasingly stressful environment at workplace.

10. Increasingly stressful environment neighbourhoods of recreational activities.

Mathur and Pillai’s set out six lines of action that need to be taken to address this crisis impacting South Asians which is a population size of over 1.2 billion and expected to overtake the population of China to become the largest population base of a single country or ethnicity such that managing diabesity that European Union states as a World-Wide challenge and which World Health Organization has declared a diabetes epidemic which is at present out of control as is also true of the childhood obesity. This task force is essential to implement strategies to protect the future generations from health devastation from the obesogenic sociocultural aspects specific to the South Asians and to prevent the unpleasant spectacle of parents burying their children whose life expectancies would be shrinking in the upcoming decades

The objective of SADPIT would be to implement the strategies proposed by Dr. Mathur and Dr. Pillai in the Lower Mainland of British Columbia.

Rationale behind urging South Asians to tackle diabesity.

Tasks for diabesity prevention includes detection of the 15% hidden or undiagnosed fraction e.g. in the EU, there are 32 million diabetics, and estimates are that additional 6 million are living with it but unaware of it. Additionally, diabesity trajectory has a slope that disease load will rise by 25% by 2030 and by 60% by 2050 such that there will be 40 million diabetics by 2030 and nearly 60 million by 2050. The numbers are similarly horrifying if not worse for the U. S., Canada, and according to the World Health Organization around 350 million people have diabetes worldwide,, and over 900 million or close to a billion humans are expected to be diagnosed with diabesity, or as having high risk of developing, type 2 diabetes within the next two decades such that by 2050 half of the human adults on the planet would have diabesity and a third of humans (35%) will have complications from diabesity. Type 2 diabetes is anticipated to shorten human life expectancy by nearly a decade between 2040 and 2050 because this disease condition leads to or contributes to coronary heart disease, stroke, peripheral vascular disease and end-stage renal disease (kidney failure), and currently it ranks at the fifth leading cause of death worldwide. Life is far worse for type 1 diabetics who suffer crippling complications and their lifespan gets shortened by over 20 years or two decades. The disease takes a far aggressive format for the South Asians as is also true of the aboriginal Indians who suffer tragic complications.

High Risk of Diabetes of South Asians especially residents of Lower Mainland of B.C.

Diabetes is a major health issue facing South Asians population, especially if they live in Western countries. South Asians have very high rates of diabase in Peel Region (15%), Ontario (12%) and the US (17%) which are considerably higher than rates of diabetes South Asian countries (9% in India, 8% in Pakistan and 5% in Nepal). The environmental shift from migration to South Asia to the Western countries doubles the diabetes risk. While the worldwide prevalence of type-2 diabetes has doubled over the past 25 years and South Asians are at particularly high risk of developing the disease with nearly 3 times increase in rated. Among South Asians, insulin resistance is a central feature of the “metabolic syndrome” contributing to development of type-2 diabetes (63). South Asians have gene pattern which carries a much higher tendency to develop the intra-abdominal fat deposits or “gut” researchers call “visceral adiposity”, which is linked with a high insulin resistance and later diabetes. The “gut” fat remains hidden or undiagnosed by using conventional BMI cut-offs, for obesity. British Columbian South Asians developed diabetes at a much younger age than elsewhere. The fat deposits or “gut” researchers call “visceral adiposity”, is generally socially well accepted and ignored which leads to problems like a nearly 4 fold higher rate of heart problems in the South Asians living in British Columbia such that prevention of diabesity becomes a very serious issue for the wellness of this group of Canadians.