Australia is now suffering an epidemic of Type 2 Diabetes according to health professionals around the country.
The epidemic is largely fuelled by an increasing percentage of people suffering from obesity.
More than one thousand people are now being diagnosed with Type 2 Diabetes each week. And, most alarmingly, the disease is attacking our children.
Serious complications with diabetes can result in heart attack, blindness, and amputations.
Insight focuses on a number of cases of Type 2 Diabetes in teenagers and young people in their twenties. We ask whether these young people could have avoided the disease through better diet and exercise. Or is diabetes determined by genes?
This program will be brought to you from the Brimbank Shopping Centre in the Western Suburbs of Melbourne.
This area has one of the highest rates of Type 2 diabetes in the country. In fact, in the past five years, the rate of the deadly disease has doubled.
With the help of locals, Insight asks experts why there's a diabetes epidemic and what to do about it.
JENNY BROCKIE: Tonight, with the help of locals, Insight is going to try and find out why there is a diabetes epidemic in Australia and how to avoid the disease. Welcome, everyone. And thanks very much for joining us. Before we get started talking, I'd just like to get a show of hands on how many people in this room actually have diabetes, type II diabetes, or have it in their families. Can you just raise your hands? Whoa! OK, that's a lot.
Now, Viet, I'd like to ask you about this because type II, or adult-onset diabetes used to be something people over 50 got. How old were you when you got the disease?
VIET NGUYEN: 21.
JENNY BROCKIE: You were 21 years old. OK, what about Stephanie, how old were you, Stephanie?
STEPHANIE: I was 15.
JENNY BROCKIE: You were 15 years old. Did it shock you? Did you get a shock when you found out?
STEPHANIE WRIGHT: Yeah.
JENNY BROCKIE: What did you do?
STEPHANIE: Well, I was a bit upset because I couldn't have all the lollies.
JENNY BROCKIE: You couldn't have all the lollies?
JENNY BROCKIE: That's part of the problem. Elizabeth, what about you, how old were you when you were diagnosed?
ELIZABETH GALEA: 23.
JENNY BROCKIE: 23? And did you think of it as the kind of thing that a 23-year-old might get?
ELIZABETH GALEA: I was expecting it, to be very honest – both my parents have it.
JENNY BROCKIE: You were expecting it?
ELIZABETH GALEA: Yes.
JENNY BROCKIE: Did you expect to get it that young, though?
ELIZABETH GALEA: No, not this young.
JENNY BROCKIE: Chantelle, what about you?
CHANTELLE McNAMARA: I was 30.
JENNY BROCKIE: You were 30. And was there a history in your family as well?
CHANTELLE McNAMARA: Yeah, there is, there's a history in my family – my father's got it.
JENNY BROCKIE: How old was he when he got it?
CHANTELLE McNAMARA: 53, my dad was 53.
JENNY BROCKIE: There's a big difference between being 30 and being 53. Was it something that you thought if you were going to get, you would get at that age rather than at 30?
CHANTELLE McNAMARA: Yeah, I thought I'd get it later but not this young.
JENNY BROCKIE: Shane Hamblin, you're the Director of Diabetes at a local hospital here. Why are so many young people like this getting it?
ASSOCIATE PROFESSOR SHANE HAMBLIN, DIRECTOR OF DIABETES, WESTERN HEALTH: Well, it's not just in this area, it's all across Australia, and we think that it's a culmination of factors. Obviously people are born with a tendency to get diabetes but a lot of it relates to the way we live – a lot of people are not as active, cars driving everywhere, less exercise and obviously eating too much – and so the net result is that the diabetes is showing up in people much younger than we used to see.
JENNY BROCKIE: Is that because we're eating less and exercising less than we used to?
ASSOCIATE PROFESSOR SHANE HAMBLIN: We're eating more and exercising less, absolutely.
JENNY BROCKIE: Eating more, sorry, yes,
ASSOCIATE PROFESSOR SHANE HAMBLIN: We'd like them to eat less. But it's a community-wide problem. We see a lot in this area but it's happening all across Australia, of course.
JENNY BROCKIE: Paul Zimmet, you're a professor with the International Diabetes Institute. Tell us what type II diabetes does to your body, what does it actually do?
PROFESSOR PAUL ZIMMET, INTERNATIONAL DIABETES INSTITUTE: Well, type II diabetes, it can be very subtle, so it can have no symptoms at all and people can have it for maybe five years before they get it. In that time they can develop complications relating to diabetes which relate to the high blood sugar, and often they have high blood pressure and high cholesterol, so it damages the arteries to the heart, to the brain, damages the small vessels in the kidneys and the eyes. So in other words, it can cause metabolic havoc.
JENNY BROCKIE: And tell us exactly, for people who don't understand how diabetes works, what is it that it does to you, that it actually does to your body when your body stops operating the way it should?
PROFESSOR PAUL ZIMMET: Well, the build up of sugar in different tissues can be toxic, toxic in a… not a chemically poisonous sense, but that causes changes in the tissue, the tissue becomes more fibrous, for example, you'll get kidney damage which will lead to kidney failure, the eye blood vessels become very fragile, can rupture, cause haemorrhage and blindness. These are the sort of changes that relate to the high blood sugar associated with diabetes.
JENNY BROCKIE: Is it treatable, reversible?
PROFESSOR PAUL ZIMMET: Type II diabetes is potentially reversible, for example, if someone is overweight, not exercising, they can…if they lose their weight and they exercise, their blood sugar levels can return to normal, in a sense they don't have diabetes. But if they then revert to the type of lifestyle that Shane mentioned, for example, more eating, less exercise, put on weight, the diabetes can come back.
JENNY BROCKIE: As I mentioned earlier, each week more than 1,000 Australians are diagnosed with this killer disease. Skye Docherty has been talking to one young man in Adelaide who's still coming to terms with his diagnosis.
MAURICE BELLIFIMINI STORY:
REPORTER: Skye Docherty
MAURICE BELLIFIMINI: There was period in February where I was feeling lethargic in myself, I was very tired, I was thirsty, I just thought I was doing a bit too much really.
Earlier this year 25-year-old Maurice Bellifimini was diagnosed with type II diabetes.
MAURICE BELLIFIMINI: Because of the family history of it, I was aware of it, I knew it was around and I knew it was going to attack me at some stage. I probably didn't tighten the screws earlier on, say after school years and stuff like that.
DR IAN CHAPMAN, ENDOCRINOLOGIST, ADELAIDE: I think it's unusual that he presented at the age of 25 but not a shock – given the fact that he does have such a strong family history, there's a very high background chance that he would get type II diabetes at some stage during his life.
But if Maurice had a better diet and exercised, things could have been different.
DR IAN CHAPMAN: I couldn't say 50s or 60s but you'd certainly delay the onset of your diabetes and you may even prevent the onset altogether.
Prior to being diagnosed Maurice didn't worry about his diet.
MAURICE BELLIFIMINI: I did grow up with Mum serving me vegetables or fruit and vegetables but I never really used to take them in.
NICOLE LEVERINGTON: Before we'd probably have hot chips rather than a salad or vegetables or something like that.
Maurice is hoping a better diet and exercise will improve his health.
MAURICE BELLIFIMINI: Can I fight it? Can I fight it and beat it? Is there one day when I've lost weight and I feel fit and he can take me off medication?
But a trip to the doctor reveals he's not doing as well as he thought.
DR IAN CHAPMAN: So you're gaining weight.
MAURICE BELLIFIMINI: Oh, excellent. How did I manage that? 106?! That's impossible. I weighed myself yesterday morning, I was 103.
DR IAN CHAPMAN: So you're going to the gym three times a week for 1.25 hours?
MAURICE BELLIFIMINI: I'm benchmarking myself at three times a week. Last week I did it. Two weeks ago I did it. Last week I didn't because my parents moved to Adelaide so I was helping them out a bit, I only went once a week.
DR IAN CHAPMAN: Do you want any more tablets?
MAURICE BELLIFIMINI: You're on a roll so you might as well write up a couple more.
DR IAN CHAPMAN: You have high cholesterol – admittedly we'll treat it. You are at increased risk of heart disease.
During the consultation Maurice was shocked to receive three new prescriptions for his diabetes.
REPORTER: So why the outcome? Why is he saying you need that?
MAURICE BELLIFIMINI: Just to thin the blood and make sure the blood flows through the veins comfortably.
NICOLE LEVERINGTON: Less risk of a heart attack. And clots. Yeah, and taking aspirin.
REPORTER: So he seems to think that that's a real possibility?
NICOLE LEVERINGTON: Yeah. Yeah.
Nicole is visibly shaken by the increase in Maurice's medication.
NICOLE LEVERINGTON: It does concern me a lot. I mean, obviously I want him to be around for as long as possible.
JENNY BROCKIE: Rick Castellas, you were diagnosed at about Maurice's age with diabetes, weren't you? What were you eating at that time? What sort of diet did you have?
RICK CASTELLAS: I didn't have a diet. I lived in Sydney in those days. Two streets away there used to be a McDonald's, Kentucky Fried Chicken. I was single. I just ate it.
JENNY BROCKIE: And how often did you eat that kind of food? Were you overweight?
RICK CASTELLAS: Very often. Yeah, I was actually, I was. And used to practically every day.
JENNY BROCKIE: And what happened to you as the disease progressed, during your lifetime? What has happened to you physically?
RICK CASTELLAS: I've lost both my feet, they've been amputated. One was in 2002, the other one was in 2003.
JENNY BROCKIE: You can still walk?
RICK CASTELLAS: Yeah, with great difficulty.
JENNY BROCKIE: With great difficulty. But you've lost your toes and lost half of your… looks like half of your foot.
RICK CASTELLAS: Yeah.
JENNY BROCKIE: When did that happen?
RICK CASTELLAS: It happened in 2002, the right foot, and 2003 was the left foot.
JENNY BROCKIE: How do you feel now about the lifestyle you had? Do you feel you could have avoided all of this?
RICK CASTELLAS: Oh, yes, yes. I was talking to one of the gentleman out there before, and if I listened to what the doctors told me in those days, in the '70s, about the seriousness of diabetes, I don't think I'd be in this position that I am in now.
JENNY BROCKIE: And why didn't you listen, do you think?
RICK CASTELLAS: I didn't think diabetes was that serious.
JENNY BROCKIE: Do other people relate to that? Do other people here don't think it's that serious? Lots of nodding of heads. Lady there, yes?
CARMEN KENNEDY: Look, I've been borderline for over 10 years.
JENNY BROCKIE: You've been borderline diabetic?
CARMEN KENNEDY: And that's moving different areas, different doctors telling me. And you just sort of shrug it off, I guess, until reality really kicks in. And while it hasn't affected my immediate family, as to Look, I think Maltese, all Maltese know that great massive amounts of Maltese people are very affected, and it's got to be the lifestyle, the diet, whatever. We're all massive sweet eaters, we're all shocking. And it's just part of growing up.
JENNY BROCKIE: But you're still a bit complacent about it.
CARMEN KENNEDY: You are, even though we're more educated, we see things, just listening to that gentleman and seeing it, it really ties knots in you because you know you're that far off. But it doesn't mean that tomorrow I probably still won't pick up a cake.
JENNY BROCKIE: Interesting. Yeah, a very honest woman here. Elizabeth, what about you, what were you eating in the run-up to this diagnosis?
ELIZABETH GALEA: All the things typical teenage girls eat – chocolate, chips, lollies, they were all my downfalls. All the junk foods.
JENNY BROCKIE: Even though you knew you were at risk – because you said earlier that you knew you were at risk, you half expected it. Didn't stop you?
ELIZABETH GALEA: No, unfortunately.
JENNY BROCKIE: Why? Why do you think?
ELIZABETH GALEA: I honestly think it's because you don't feel any physical pain. A – you don't feel anything, you don't know that your body is going through it.
JENNY BROCKIE: You don't get a warning?
ELIZABETH GALEA: You don't get a warning. It's not like breaking your leg – you feel pain so you stop moving your leg in that direction – but you're not feeling any physical aspects to it all so you…I think you sort of think that it's not that bad.
JENNY BROCKIE: And now?
ELIZABETH GALEA: And now it's changed. And now I know it's bad.
JENNY BROCKIE: Dick, yes?
DICK ADAMS, TASMANIAN LABOR SENATOR: I think we're dealing with the issue of diabetes II. I think you need tools to deal with it and what we're hearing here now, those of us who have got diabetes II, we're dealing with a medical model which is diagnosed as – which I think is failing. I think we need to look at other models as well as a medical model to help us solve this problem.
JENNY BROCKIE: What do you mean by other models?
DICK ADAMS: We've got a chronic lifestyle illness, chronic lifestyle illness.
JENNY BROCKIE: And you have the illness?
DICK ADAMS: Yes, I do.
JENNY BROCKIE: And there are other parliamentarians who have the illness too, you've got a support group in Federal Parliament.
DICK ADAMS: We do. And we have number one diabetes as well. What I mean is that I think it takes up to 9 to 12 weeks for people to go to their GP, then go through the ad hoc process of getting screened and going off to get their eyes done and feet done and blood, etc. I think that is too long and I think we need to have a system which can assist people to meet challenges of behaviour and lifestyle, and I think that can take up to 20 hours of face-to-face contact. And I think we need to have a blended model of medical and lifestyle behaviour change.
JENNY BROCKIE: OK, we're going to get on to that a little bit later. Mary-Anne Papalia, you're Elizabeth's endocrinologist and you have a diabetes clinic in this very shopping centre, don't you? Do people realise how serious this is, do you think?
DR MARY-ANNE PAPALIA, ENDOCRINOLOGIST: I think they don't. I think it's when people don't have symptoms of an illness they don't realise. You can tell them “Look, you're running with high sugars and these are the potential complications you're going to…may have – It might block your arteries, you might lose your vision, your kidneys might fail.” And so they don't actually realise it because it's not something they feel, feel to know that it's really a problem.
JENNY BROCKIE: I'd like to talk a little bit more about diet because I think it's something a lot of people watching this are going to relate to. Judith, you run the canteen at the local football club here, what's the most popular food you serve at that canteen?
JUDITH TAVERNA: Hot dogs.
JENNY BROCKIE: And after hot dogs?
JUDITH TAVERNA: Pies and then it's chips – anything that can be fried, virtually.
JENNY BROCKIE: Anything that can be fried. OK. What about salad rolls and things like that?
JUDITH TAVERNA: No, you get very few people wanting them.
JENNY BROCKIE: Do you serve them?
JUDITH TAVERNA: I will make them for them if they want them.
JENNY BROCKIE: How often would you make a salad roll?
JUDITH TAVERNA: Over the football season I think I've only made two.
JENNY BROCKIE: You've made two salad rolls over the whole football season this year?
JUDITH TAVERNA: Mm.
JENNY BROCKIE: Paul, how do you feel sitting here listening to this as one who's trying to battle this disease?
PROFESSOR PAUL ZIMMET: Well, it's disappointing. We actually just had an editorial in the 'Medical Journal of Australia' yesterday on the diabetes issue. It hit the airwaves. And one of the areas – we said that we need to see better food served not only in hospital canteens and in school canteens but even at the football grounds.
JENNY BROCKIE: But Judith is saying that the football club would go under, the canteen would go under without this food.
PROFESSOR PAUL ZIMMET: I think it comes back again – and Jo and some of the others may feel they want to say something about this, they're more expert than I – but it gets back also to parental education about proper diet and also having better education in the schools about nutrition. These are things, along with physical activity, that have been thrown out of school agendas for other reasons.
JENNY BROCKIE: Judith, you're nodding your head and you have diabetes too, don't you?
JUDITH TAVERNA: Mm.
JENNY BROCKIE: When did you find out?
JUDITH TAVERNA: When I was 56.
JENNY BROCKIE: And have you got symptoms now of the disease? What sort of symptoms?
JUDITH TAVERNA: Oh, um
PROFESSOR PAUL ZIMMET: Are you thirsty, are you tired?
JUDITH TAVERNA: Oh, yes. Yes, thirsty, tired, all those.
PROFESSOR PAUL ZIMMET: Blurred vision?
JUDITH TAVERNA: No, no.
JENNY BROCKIE: Has that been a wake-up call? Has it changed what you eat?
JUDITH TAVERNA: Definitely.
JENNY BROCKIE: Are you sure?
JUDITH TAVERNA: Yes, yes.
JENNY BROCKIE: In what way? Tell me what
JUDITH TAVERNA: Just recently, I've been to the doctor and he wasn't very pleased with me, and he told me I had to lose quite a bit of weight, more exercise and, you know, change my eating habits, which I've done.
JENNY BROCKIE: Angela, you're a local dietician. Is there anything special about the lifestyle in this area, do you think, given that there seems to be a particular problem here, or is it pretty typical of lots of places?
ANGELA WALKER, DIETITIAN: I think the diet that's shown in the western suburbs of Melbourne are very typical of other areas of Australia. And unfortunately our lifestyle is as such that we are people are relying more on the takeaway foods, the convenience foods they can go home and just quickly cook up. And definitely there's a lot more refined carbohydrates that people are consuming.
There was a survey that they looked at generally what Australians were eating and they found that on average we were still eating a lot of fat, too much fat, but we weren't eating any more. But the major change is we were getting a lot more of our calories from carbohydrates and they weren't from breads or cereals or fruit, it was from soft drinks, it was from fruit juices and it was from a lot of the refined carbohydrates like biscuits.
JENNY BROCKIE: That was the other thing I was going to ask you – the chips and, you know, burgers dripping with fat and everything else, they're all predictable things. What other foods should people be avoiding? What other kinds of things shouldn't people be eating?
ANGELA WALKER: I suppose I'd like to think of myself more as a food liberator and educating on people on what foods to be including more of so then there's less room for other foods that are occasional foods.
JENNY BROCKIE: So squeeze them out.
ANGELA WALKER: Yeah.
JENNY BROCKIE: So what should we be eating? Because that's what people are going to want to know. The obvious things. What are the less obvious things people should be careful of or should include.
ANGELA WALKER: Looking at the carbohydrate foods again – because carbohydrates are our primary fuel source so they are vital foods to include every day and they are filling and provide fibre and vitamins and minerals. But really looking at the ones that research has shown scientifically to be the ones that break down gradually, so release sugar into the bloodstream over
JENNY BROCKIE: And what sort of things are they?
ANGELA WALKER: When you look at your breads, they're more the more natural, unprocessed breads like the grain breads. With cereals, it's the, again, natural cereals like oats and muesli. A lot of the foods that fill us up, so going back to basics like nuts, legumes, like baked beans, fruits. So our basic foods, I often say, going back to those choices.
JENNY BROCKIE: Is there any difference between different types of sugar?
ANGELA WALKER: Definitely there is. If you look at some foods, people may look at a label and exclude them because it looks like it's high in sugar but it may be coming from fruit, and there's a lot of cereals, even breads and biscuits that can be still suitable because of the sugar coming from fruit.
JENNY BROCKIE: So sugar coming from fruit is better than refined sugar?
ANGELA WALKER: It's a sugar that does break down slowly and also fruit doesn't contain just sugar, but it contains vitamins, minerals and fibre as well. So it's a nutrient-dense way of getting in sugar.
JENNY BROCKIE: Janet, I want to ask you why it is You're a psychologist and you deal with behavioural eating problems. Why is it that people crave this stuff that's so bad for them in large quantities?
JANET LOWNDES, PSYCHOLOGIST: I guess there's not a single answer. I think that there are probably many answers to that and it's different for each individual person. But I very much agree with the issue about changing a habit, and eating is habitual behaviour. Changing a habit is not about stopping doing the habit, because it then leaves a void that we tend to replace by bringing the old habit back again, but instead it's about building new habits, so moving towards the kind of behaviours that we do want, that we know are beneficial for us and are taking us further towards our goals.
JENNY BROCKIE: And this isn't just about the things we eat, it's about the amounts we eat as well. Why do we overeat?
JANET LOWNDES: Habit is the first reason that I would always highlight. The second one would be about coping, that I think we often use food as a coping strategy. We cover up thoughts and feelings with food. We use food for comfort, especially with a lot of non-hungry eating when we eat purely because we feel like we want that comfort or sense of satisfaction, then it's good to try and look at other ways, more healthy, more positive ways to actually meet those needs.
JENNY BROCKIE: It's a good idea to think about whether you're hungry or not. Paul, because eating too much is a problem as well, isn't it?
PROFESSOR PAUL ZIMMET: Also not exercising enough is probably a bigger problem, to burn it off.
JENNY BROCKIE: Yes, Maggie.
MAGGIE MILLAR, ACTOR: I think we need to put this into context when we talk about food and eating. If you think about the number of times we're exhorted on television to eat food, to buy food, if you think of the number of articles in magazines and newspapers about food, good, bad or indifferent food. I mean, I don't think there's any bad food, I think there are occasional foods and everyday foods.
JENNY BROCKIE: Now, you've got diabetes as well.
MAGGIE MILLAR: I have, yes.
JENNY BROCKIE: Was that weight related? Was it diet-related? What was your lifestyle like? You're an actor.
MAGGIE MILLAR: In my profession I had to look good so I always have looked after myself, I've always exercised. When I hit midlife I was put on HRT and I gained weight, whether that was just because of the HRT or not, I don't know, maybe the endocrinologist in the audience could tell me that, but I did gain weight quite a lot. I was actually tested for diabetes at the time and nothing showed up.
JENNY BROCKIE: OK. So you weren't overweight at that time?
MAGGIE MILLAR: No, I was not.
JENNY BROCKIE: And you were exercising at that time?
MAGGIE MILLAR: Yes, I've always
JENNY BROCKIE: But there was a family history?
MAGGIE MILLAR: Family history – out of six siblings, three are diabetic.
JENNY BROCKIE: Peter Howard, we've been talking a lot about food here. You're a celebrity chef and you've presumably had some access to some pretty fabulous food in your time. How did you get diabetes?
PETER HOWARD, CELEBRITY CHEF: Just exactly that. I think one of the things we should take into account, and it's been put around here tonight, is that, you know, Australia's middle name is abundance, you know – we can have anything that we want in this country and at a very, very inexpensive price. And so therefore there is no… there's no restrictions – you can just have it, you can buy it. You go into the shopping centre, there are 10 places where you can have food and that's one of the things. Mine was purely about excessive You know, my mantra was nothing succeeds like excess and I got it and I certainly lived that whole thing.
JENNY BROCKIE: So what were you eating?
PETER HOWARD: Anything, anything.
JENNY BROCKIE: Anything?
PETER HOWARD: Anything. I was on the see-food diet – see it and eat it. And preferably I loved, you know, deep fried I'd go to France and I'd just pig out on foie gras and all those sort of things that really just made me, eventually, obese. And then, you know, I got the good news that I had type II diabetes.
JENNY BROCKIE: Artie, you were on the TV show 'The Biggest Loser' and you were diagnosed with type II diabetes, I think, more than five years ago.
ARTIE ROCKE, BIGGEST LOSER CONTESTANT: That's correct, yep.
JENNY BROCKIE: And since then you've lost 62 kilos.
ARTIE ROCKE: Yeah, that's over a period of eight months as well.
JENNY BROCKIE: How?
ARTIE ROCKE: Through exercising six hours a day during the duration of the show, continued that when the show finished. My daily routine now is two hours every day of exercise and count calories and I know that's the way I'm going to live the rest of my life. And although my type II is dormant, I'm totally off my medication, and that's my prize in that sense, that I no longer have to take medication for type II diabetes. Where my lifestyle was my eating was out of control, totally out of control. And I thought by not having sugary drinks or not putting sugar in my tea and coffee was doing the right thing and that's pretty much what I did when I found out I had type II diabetes. I didn't really look into it where I needed more of the education. And I think since this journey started for me it's all fallen into place definitely for me.
JENNY BROCKIE: OK, because getting that under control must have been an enormous mountain to climb, to lose that much weight.
ARTIE ROCKE: Yep. Well, I still want to lose another 8 kilos so I'm finding that the hardest at the moment, and then maintaining it, so that's it.
JENNY BROCKIE: Yes.
LAUREN KENNEDY, BRIMBANK SECONDARY COLLEGE: I agree with the psychologist here because humans are habitual creatures and we are not being educated enough at school. I think if more education systems come in and teach the younger people, then they're more likely to think of more healthy options.
JENNY BROCKIE: Lady here?
CARMEN KENNEDY: As a mother of three, I can say I would be coming home from work – and I was lucky enough the kids weren't in a creche, they were always with my family, so you knew they were getting, you know, good home-cooked sort of meals, Mum was making the veggies, making sure the kids got the right share of everything. But I'd be driving home with my children and they'd be lucky to know the word 'Mummy', but they could go past as we're driving home through this area, and point McDonald's and say the word because of commercials – 'Kentucky' – these were like their third or fourth words in their vocabulary, purely driving along. And I would be just dumbfounded at how young a child knew those golden arches or, you know, that Colonel's picture or whatever. So commercials are so strong that even way before prekinder age these kids are already being brainwashed.
JENNY BROCKIE: Cue Russell Howcroft. You're our advertising rep here, what's your answer to that?
RUSSELL HOWCROFT, CHAIR, AUSTRALIAN FEDERATION OF ADVERTISING: It's interesting, isn't it, because advertising is on the television to promote foods, obviously, all sorts of foods, good ones and bad ones. But equally advertising is being used, sorry, television is being used more and more as an educator. Just this year you've got the nanny program – which is teaching people how to be parents – you've got 'Honey We're Killing the Kids' – which is another television program which I think is doing a fantastic job at education, – we've got the show that our friend here was on here as well where we're seeing I think what's happened is that there's been a real swing in terms of television programming.
JENNY BROCKIE: But there isn't a swing in terms of advertising.
RUSSELL HOWCROFT: That isn't really true because the industry is the industry is very heavily regulated. You've got The statistic is something like 30 years ago, 80% of school kids walked to school, now 8% walk to school.
JENNY BROCKIE: But aren't you deflecting away from the advertising argument here?
RUSSELL HOWCROFT: The causal relationship is very difficult. If there was an absolute causal relationship – remove the advertising, type II diabetes doesn't happen.
JENNY BROCKIE: That's what they said about cigarettes.
RUSSELL HOWCROFT: Yes, well, I'm not so sure that The cigarette argument, of course, was that there is a ceiling of people who smoke and advertising was just competing within that ceiling. So that's an argument which the cigarette manufacturers lost.
JENNY BROCKIE: But we now know cigarettes kill people and we do know that eating too much bad food or too much fast food can contribute to a disease which can kill you.
ARTIE ROCKE: Is McDonald's going to put fat people on wrappers?
JENNY BROCKIE: Pardon?
ARTIE ROCKE: Is McDonald's going to put fat people on their wrappers so when you're about to eat a burger you see this obese person looking at you, like they're doing with the cigarette packets now?
RUSSELL HOWCROFT: Only if it was legislated to be the case. But I don't think there'd be any of these food manufacturers, none of them expect people to go there for breakfast, lunch and dinner and none of them expect people to have four litres of it to drink a day.
JENNY BROCKIE: But they like it when they do because it makes money.
RUSSELL HOWCROFT: No, I'm not sure that they do. I'm not sure that that is the case, certainly anymore. I think there is a much stronger sense of what's appropriate.
JENNY BROCKIE: Shane?
ASSOCIATE PROFESSOR SHANE HAMBLIN: I'd just like to make the comment at the hospital I work at 70% of our people are born overseas and they all bring with them their cultural beliefs – and family is food. Often we have to work out when we're talking about the main meal, is it the evening meal or is it lunch or is it some other time?
JENNY BROCKIE: We've mentioned this business of exercise a few times and we haven't really gotten on to it. We've talked mostly about food. Paul, how big a factor is obesity and diet in diabetes, and how much is it about other things as well?
PROFESSOR PAUL ZIMMET: Obesity is the main driving force of type II diabetes and it's of course the driving force of the childhood obese well, type II diabetes epidemic. But Jo Salmon here is one of the world experts on this whole issue of television and exercise, and perhaps it would be best to get her to comment.
JENNY BROCKIE: OK, Jo, do you want to..
JO SALMON,DEAKIN UNIVERSITY: Look, I think that the argument about energy balance is a moot point. I mean, we're not trying to say that physical activity is more important that what you eat. And, yes, I think some of the food and soft drink companies are very clever at trying to deflect the argument and saying it's inactivity that's the issue. I think both are important – you need to have a balance. But interestingly the research that we're doing is suggesting that it's not just the physical activity and the amount of energy you expend at an intensity that's sort of good for health – like moderate intensity or higher which is like a brisk walking pace – it can also be the lighter, just incidental movement, just the moving that we don't tend to do anymore in our lifestyles. There've been a couple of mentions about sedentary lifestyles but I think in terms of evidence, over the last 20 years there's certainly good evidence of increases in sedentary lifestyles in our recreation, through computer use and Internet.
JENNY BROCKIE: And you're seeing that in children a lot, aren't you?
JO SALMON: We're seeing it in children. And there's also emerging evidence in a very new area of research of independent health effects from sitting too much, over and above how much exercise you do, So you can meet physical activity guidelines but if you sit for too long, then you're going to be independent health risk.
JENNY BROCKIE: So get up and walk around, move, move, move. Hayley, you're 15, how much exercise do you do?
HAYLEY SOMMERLING, BRIMBANK SECONDARY COLLEGE: To be honest, not too much. But I don't want to speak on behalf of everybody in my age group because I have heaps of friends who are highly involved in school sports, sport activities outside school, just exercise in general. I don't want to stereotype them.
JENNY BROCKIE: So why aren't you? Why aren't you, though? Let's just talk about you. Why don't you do much exercise?
HAYLEY SOMMERLING: I just never really get around to it. I'm highly involved in academics and I…yeah I've never actually really found a sport that I'm really interested in and I'm not very good at, like, motivating myself to exercise.
JENNY BROCKIE: Shane, I'm wondering how much exercise can lower the risk of getting type II. And I wonder how much one thing plays into the other. I mean, is it possible to eat badly and exercise a lot and be OK, or is it possible to, you know, not exercise and eat really badly?
ASSOCIATE PROFESSOR SHANE HAMBLIN: We negotiate every day. My worst patient is a doctor – doctors are hopeless following our own advice. There are notable exceptions in this audience. But I think that there have been three studies that have been very important – one in the US, one in China and one in Scandinavia – all showing that people on the borderline of diabetes who do exercise and follow a reasonably good diet can prevent the onset of diabetes by up to two-thirds.
JENNY BROCKIE: By exercise what do you mean? How much?
ASSOCIATE PROFESSOR SHANE HAMBLIN: Each of those studies use different forms of exercise and basically any exercise that will get your heart rate up and you do it often enough. And you might be able to tell me exactly how much. But I usually tell my patients five days out of every seven, try to do 30 minutes, 40 minutes, it doesn't really matter what it is.
JENNY BROCKIE: OK, and you're saying that can actually reduce the risk by up to two-thirds?
ASSOCIATE PROFESSOR SHANE HAMBLIN: Yes, of progression to diabetes.
JENNY BROCKIE: Nowhere is the problem of lifestyle related diabetes more apparent than in Australia's Indigenous communities. Skye Docherty visited Thursday Island in the Torres Strait where an alarming number of children are being diagnosed with the disease.
CHILDREN OF THURSDAY ISLAND STORY:
REPORTER: Skye Docherty
Between Cape York and Papua New Guinea lie the island communities of the Torres Strait. Here are Australia's highest rates of type II diabetes. Nearly 30% of the community have the disease.
MAYOR PEDRO STEPHEN, CHAIRMAN, HEALTH COUNCIL: Sometimes you have majority of the families are involved or have been diagnosed with diabetes and you're virtually asking the wounded to pick up and to actually care for the other wounded. My father and mother was diagnosed with diabetes. My mum died of stroke and my father also died of stroke.
One of the most scary parts of the data is that revelation that our children have been identified 5% of those children has been identified with diabetes, and that's type II.
13-year-old Atima Baira from the small island of Badu was diagnosed with type II diabetes when she was just 9 years old.
ATIMA BAIRA, (Translation): I became cross-eyed and I fell down and my dad came and picked me up. That is when I found out. When I found out, they gave me insulin and a metamorphine tablet and they took a blood test.
Dr Sinha has been treating the children of the Torres Strait for the past decade. Every three months he flies to Thursday Island where Atima is now at high school.
ATIMA BAIRA, (Translation): When I am in the house I just drink soft drink and juice. When my parents say, “Atima, take insulin and take the blood test,” I always reply, “In a minute, in a minute.” In the evening, my mum reminds me again and again.
In 2000, Dr Sinha reported the first case of type II diabetes in a child. The boy was just 6 years old. Since then, they have started diabetes screening at the schools.
DR ASHIM SINHA, DIABETES SPECIALIST: We identified about 20 children whose mean age was about 13 years and most of them had a very strong family history of diabetes.
Give you a bump, an insulin bump which might get you under better control.
Most of the children with type II diabetes, I would say 70% or 80%, would be…would be obese.
Obesity is at the heart of the diabetes epidemic. The Islanders are killing themselves with the foods that they love.
MAYOR PEDRO STEPHEN: We need to actually change the tastebuds in people's lifestyle because they're so used to have access to the chocolate, to the biscuits, the tinned stuff, the processed stuff.
But the cost of fruit and vegetables is out of reach for most Islanders.
DR ASHIM SINHA: I think that, you know, with the growing epidemic of obesity all over the world, and particularly in children, and it doesn't matter whether it's indigenous or non-indigenous children, like because you have more diabetes in indigenous populations, you'll see more, but I think with the growing childhood obesity we're going to see more and more of these type II diabetes even in non-indigenous population.
Atima's grandmother lost her leg from diabetes. She's worried a similar fate might await her.
ATIMA BAIRA, (Translation) When I get older, I might get my leg and toe amputated from diabetes.
JENNY BROCKIE: Paul Zimmet, how did you feel watching that? And, I mean, who is going to buy a lettuce that cost $4.90?
PROFESSOR PAUL ZIMMET: I feel desperate. And that's one of the reasons we've mentioned in the editorial in the medical journal yesterday to be looking at subsidised fresh fruits and vegetables and good meats and fish at much lower prices, subsidised for rural and remote communities and Indigenous communities.
JENNY BROCKIE: And you also want to tax fast food, don't you?
PROFESSOR PAUL ZIMMET: Well, I don't know whether that will fly with our Government.
JENNY BROCKIE: It won't fly with the Health Minister.
PROFESSOR PAUL ZIMMET: It won't fly with a lot of people but it's certainly one of the things that have been suggested.
JENNY BROCKIE: Can I ask you a little bit more about that story, though, because I wonder – obesity is obviously a big issue but are there particular ethnic groups that are more inclined towards getting diabetes?
PROFESSOR PAUL ZIMMET: That certainly is the case. My own original work was in Nauru, which has the highest rate of diabetes in the worldWHEREas before World War II there was no diabetes. It was the change in lifestyle. Similarly in Pacific Islanders, our Indigenous community, the American and Canadian Indian communities, Asian Indians and Chinese, in this area the ethnic groups are probably one of the reasons for the very high rate of diabetes.
JENNY BROCKIE: Viet, do you relate to any of that because you got diabetes and you weren't overweight particularly, were you?
VIET NGUYEN: No, I wasn't. When I was diagnosed I wasn't overweight but if I think back to when I was a little bit younger, I was. I did lose a lot of weight in the process and didn't realise and I guess that's because I wasn't educated, I didn't know the risk of diabetes or the symptoms of diabetes. There's no family history, I come from an Asian background where my father doesn't have it, my mother doesn't have it. And when we talk about our grandparents at my age, in our country there's no facilities, it costs them too much to go see a doctor so they don't know of any symptoms or what they have healthwise.
JENNY BROCKIE: Lady over here, yes?
CARMEN KENNEDY: I think we hit the nail on the head a few times in this is the lucky country, it's the country of abundance. I'll go shopping every day and there's always lots of fresh fruit and lots of vegetables, and the children get all of that every day. But it's the quantity of what we eat as well and we I know I'm guilty of just eating because it's there and it tastes good. And it might be healthy but I'm still eating way more than I possibly need, and it becomes habitual.
JENNY BROCKIE: Why are you laughing, Paul?
PROFESSOR PAUL ZIMMET: Actually I coined a term recently. You know, in winter the major disease is influenza, what we've got in this country is affluenza.
AUDIENCE: Yes, yes.
PROFESSOR PAUL ZIMMET: But I wouldn't like to see us leave the message at such a desperate situation now. There's a lot we can do in the area of type II diabetes with proper nutritional advice, with exercise, we've heard the beneficial results.
JENNY BROCKIE: But there's a need for something drastic, isn't there? We're looking at a real health crisis here.
PROFESSOR PAUL ZIMMET: We are looking at a major crisis. And it was very encouraging three weeks ago, that COAG – the Prime Minister and the Premiers of each of the States got together and they've declared diabetes as a national health priority, and there's a plan now for major intervention programs and prevention programs being discussed. So there are some good things happening.
JENNY BROCKIE: Maurice?
PROFESSOR MAURICE EISENBRUCH, DIRECTOR, HEALTH AND DIVERSITY INSTITUTE:: I want to pick up on something that could also help, and it comes back to diversity. And Brimbank and in this part of Melbourne where we're sitting, the fact is we do have, as has been said before, people who bring very good, healthy habits of life with them, or who may have had those habits in the countries from which they came and who learn bad habits. So maybe we just need to turn this around and see how we in Australia can learn better habits from diets from other countries or from lifestyles from other countries.
JENNY BROCKIE: Paul, are we we've talked a little bit tonight about family history – it's come up again and again and obviously it's a very big risk factor for people if there is a family history of diabetes. Are we any closer to identifying what gene might be responsible here and is there any hope for gene therapy or gene treatment?
PROFESSOR PAUL ZIMMET: That's a great question. What we really haven't pointed out tonight is there are a number of, maybe 10 or 15, different causes and types of type II diabetes. So someone may be on an absolutely healthy diet and because they have a very strong family history or genetic potential they'll get it without putting on much weight or because they didn't exercise, for example. There's been a huge amount of research looking for those genes, it's been very limited success so far but what's come out of it is a better understanding of what the metabolic causes are of these different types of diabetes, so we're getting better drugs now to treat type II diabetes.
JENNY BROCKIE: Maurice, you're funded by the Victorian Government to head a diabetes program here, in this area. What does it involve?
PROFESSOR MAURICE EISENBRUCH: The funding is from a range of sources. And our program is looking at the cultural diversity and to see what we can do through prevention and treatment that is culturally appropriate to reduce the risk and reduce the effects of diabetes on the very diverse community in the western part of Melbourne.
And the way in which we do this is we're trying to understand from the perspective of the people and the communities what's going on for them about all the issues that have been discussed this evening. So that instead of doctors or health workers telling people the standard line, and maybe having it translated, we put it together in a way that's going to work for those communities.
JENNY BROCKIE: Jo, you're being funded to encourage kids to do more exercise. How are you going to do that?
JO SALMON: I think that primary prevention is critical, particularly, you know, with this increase in prevalence and incidents that we're seeing. And starting with children at a young age and working with children and also their parents and families is really, really important. The work that we're doing, we're doing curriculum-based programs that link up with different sectors of the community to increase children's, I guess, awareness.
You know, we encourage them to monitor how much TV they're watching, how much physical activity they're doing and to increase, encourage children to actually be responsible for their own decision making even at a young age when children can make the choices at the canteen or in their own pantry if need be. And also reverse the pester power – get children, like we did in the past with sun smart campaigns and seatbelt wearing and quit smoking, get children to start nagging parents about healthier lifestyles.
JENNY BROCKIE: Can we do – we are running out of time – a quick whip around just a few people of what you think might work, what might work to shift people's complacency about this issue. Yes?
JANET LOWNDES: I think we need to focus on lifestyle. The focus is on what we want rather than what we don't want. I think we need to be very careful not to just be reactive and to base our responses on fear, but to instead be talking to people about lifestyle changes about increasing your wellbeing, and wellbeing being on a psychological and physiological level, and also in other aspects that are about enhancing the way you live your life. So talking about increased energy, being able to get out there and be part of the world around you.
JENNY BROCKIE: So positive messages.
JANET LOWNDES: Messages about what we do want rather than just being afraid of what might happen if we don't.
JENNY BROCKIE: Young woman here who was talking before about being shocked, what do you think – at work, at schools, what do you think would shift people's behaviours?
LAUREN KENNEDY: Show them some of those DVDs. Well, the thing is yeah, show them some of that stuff that you're showing us. Have people like that man over there come in and speak to us, show us that, you know, it's serious and, like, show… Children don't listen to teachers but they do listen to people who have been through things.
JENNY BROCKIE: I think that's true, actually. You might laugh but I think it's very true.
LAUREN KENNEDY: At a high school level – because I am around all of the people that don't listen and I'm used to having them not listen – but then I'm also around them when a football player comes in and tells them about something and they all get excited. It can work in the other way. If, like, someone with a disease comes in and tells them, they're more likely to listen to them than a teacher.
JENNY BROCKIE: Artie, quickly.
ARTIE ROCKE: I think it's education. I do believe it starts at home with the parents. And I think if more gentlemen or more men over 20, actually, when they go to the doctor or do go to a doctor, certainly do ask for a blood test at least.
JENNY BROCKIE: Dick?
DICK ADAMS: If most GPs got scales in their rooms that could weigh people over 150kg because I would suggest that in all the GPs' rooms around Australia 98% of them could not weigh me.
JENNY BROCKIE: And can I ask you what efforts you've made to reduce your weight, to try to reduce your weight?
DICK ADAMS: I've been a heavy person all my life and have spent a lot of times on diets and have failed many times. I keep my sugar level under control by walking and by diet, but lifestyle is a real problem for me.
JENNY BROCKIE: Paul Lacey, you weigh 140 kilos. Are you worried about getting diabetes listening to all of this tonight?
PAUL LACEY: Yeah, absolutely. I think one of the areas we haven't talked about is actually the corporate demands. We talk about obesity being a precursor to diabetes and yet I think I see colleagues that obviously have increases in chronic fatigue syndrome and in glandular fever and in strokes, and obviously there's massive time off and then a transition back to work. But certainly for someone that's obese it's almost like you run the race, there's no strategies in place and then you either have the attack and you survive or you don't.
And I think that perhaps what we need to do – and perhaps I'm being a bit of utopia here – but maybe we need some sort of obesity regulators that if there are people that are actually in this predicament, maybe we need to be saying, “Well perhaps this person needs time off now to see dieticians, to see personal trainers and actually, you know, stop some of these issues.”
JENNY BROCKIE: What are you doing to try and stop of your issues, what are you eating?
PAUL LACEY: Yeah, look, I think like all the wrong things. And I suppose a father with three children it's really hard because generationally I see my bad habits playing out in my children.
JENNY BROCKIE: So what do you eat? Just as we're wrapping up, what are you eating?
PAUL LACEY: I think I like all the good things, I like all the bad things, perhaps a little bit like our celebrity chef, in excess. And I think it's…yes, it's sushi and it's great stir-fries but it's also lovely camembert and brie and all those other things as well.
PETER HOWARD: We can learn to say no. That's the discipline
JENNY BROCKIE: Shane, if you look at Paul, if Paul comes to you and you look at Paul, is he at risk, is he at high risk of getting diabetes?
ASSOCIATE PROFESSOR SHANE HAMBLIN: Yeah. But Paul would just dissolve into all the others. The thing is this is not just an individual that is eating the wrong food. There are thousands upon thousands of Pauls. I mean, our new patient waiting list is six months for a new patient with diabetes. So we're constantly overbooking the clinics.
JENNY BROCKIE: That is really… that is a really scary figure. Just to wrap up, Paul Zimmet, if people don't change their lifestyles in Australia, could we see the first generation of people who are going to die at a younger age than their parents?
PROFESSOR PAUL ZIMMET: I think that's already happening. And I would hope, seeing we're here in the western region, we should send a message to our State Government that we have the worst facilities here in this region for managing diabetes – a lack of dieticians, a lack of chiropodists, podiatrists, a lack of Shane. And we'll need a lot more endocrinologists, diabetes educators.
JENNY BROCKIE: And a plethora of fast food.
PROFESSOR PAUL ZIMMET: Yeah. So there's a real challenge.
JENNY BROCKIE: And Judith, just to wrap up, are you planning any changes at that canteen of yours?
JUDITH TAVERNA: Oh, definitely.
JENNY BROCKIE: What's going to happen?
JUDITH TAVERNA: They're not going to be getting any lollies next year. I'm going to eliminate their dim sims.
JENNY BROCKIE: You're going to take it slowly, you're going to take it very slowly?
JUDITH TAVERNA: Yep. And then I'm also going to eliminate their egg and fried bacon rolls.
JENNY BROCKIE: How do you think that will go down?
JUDITH TAVERNA: Not very well.
JENNY BROCKIE: But you are prepared to be brave?
JUDITH TAVERNA: But we are going to be introducing salad rolls and things like that and more on the fruit juices instead of the Coca-Colas and that sort of thing.
JENNY BROCKIE: Good luck. I think certainly the group here would wish you good luck at the football club.
JUDITH TAVERNA: It'll be difficult but I think I'll get there.
JENNY BROCKIE: Thank you very much for joining us. I'm sorry, we do have to wrap up. We're out of time. But thanks everybody very much. It's been really interesting to talk tonight.