How Behavior Change May Reverse the Trend of Diabetes in America

How Behavior Change May Reverse the Trend of Diabetes in America

How do you change the health behaviors of 120,000,000 Americans? Is it time to try something new? Think about those two questions for a moment.  

There are roughly 90 million Americans with pre-diabetes and 30 million with diabetes.

According to the CDC, 15-30% of those with pre-diabetes will develop diabetes within 5 years without weight loss and moderate physical activity.  And of course, most, if not all, would benefit from significant change in other lifestyle factors that include composition of their diet, stress reduction and sleep optimization, among others.

How Pre-diabetes has Risen in the Last Century

In 1880, the prevalence of diabetes was a mere 0.3%.  Before that was a VERY rare disease for literally millennia.  Since my completion of medical school in 1977, the prevalence of diabetes has risen from roughly 1.5% to currently about 10% or our entire population.  It is expected that by mid-century – 22 years from now, 33% of the entire population of the US will have diabetes!

In the past half century, we have had revolutionary medical advances in the therapies for this illness, but we have somehow forgotten that diabetes is almost totally preventable (and in some cases reversible)!  

Somehow, we now come to accept that one in 3 will develop diabetes… why?  

We don’t have to accept this as fact.  We may in fact reverse this trend with a rather simple approach… behavior change.  And besides new $500 per month medicines, what choice do we have?

How Behavior Change May Reverse the Trend of Diabetes

The key is to actually focus on behavior change at the population level.  But there are challenges. People seem to often make “irrational” health related choices.  They don’t do what they need to do to optimize their health. This “irrational” behavior however, has been studied for decades.  The fields of health psychology and behavioral economics have provided us ample understanding of why this happens, when this happens AND methods for helping  people make change by taking into account their motivation, habit strength, and competing environmental factors.

Over 80 theories on how to change health behavior have been developed, studied, categorized, published and have proven to be effective – but not for 120,000,000 people.  The theories all rely on one-on-one or small group interventions and they work. But the human-to-human model cannot be scaled to 120,000,000 people.

What is needed now?  Again, I ask, WHAT IS NEEDED NOW?

Most readers would say: new diagnostics, new drugs, stem cell therapy, a gene edit, a transplantable pancreas, major breakthroughs in treatment…

But what is really needed is a way to change the behavior of 120 MILLION! people.  But those of you reading this “know” that this is impossible… so you list those things above.

Certainly what is needed is innovation, but not in the treatment or diagnostic side.  What is needed is a scalable way to actually change the behavior of 120,000,000 people.  Public policy will help; think about all of the “No Smoking Allowed” laws. Changing the view of “acceptable” behavior will help (think about how unaccepted it is to smoke).

But what is also needed is a way  to deploy behavior change methods to 120,000,000 people.  We know how to change behavior, but we have always thought that it takes people to change the behavior of other people.

How Software & Computer Technology May Pave the Way

If Silicon Valley has taught us anything, it is: software and computer technology absolutely has the potential to change people’s behavior. We are literally addicted to our smartphones. We deposit checks with a photo and an app. We cannot stop texting; even while driving. We cannot go to sleep before checking Facebook. We are accustomed to “instant” updates from our family and even news organizations. We have forgotten how to look at a map –  the list goes on.

All of these are inanimate software applications and hardware.

Upcoming blog posts will highlight some of the ways computer innovation, the use of BIG DATA, software, apps, even avatars, are being developed to start to reverse the epidemic of diabetes…

My final question:  The technology is available, the problem is immense, who will risk little to prevent so much?



*(Note: Type 1 diabetes, an autoimmune disease has a prevalence of about 0.5% according to current reports… this discussion talks about Type 2 which is primarily lifestyle based)

Tom Morrow