One of the biggest dangers faced by Americans comes not from outside the country’s borders, but from within.
The way Americans eat and how they move — or don’t move — is driving the country’s high rates of obesity, heart disease, stroke, and type 2 diabetes.
And it’s putting a dent in our wallets.
Take diabetes, for example.
A new government report found that almost 10 percent of U.S. adults have diabetes, with many more in the early stages of the disease.
The annual price tag for this chronic illness runs into the billions of dollars for medical care and lost productivity.
As bad as that seems, other research shows that left unchecked, one-third of American adults could have diabetes by 2050, with an equally staggering blow to the U.S. economy.
All numbers up and to the right
A report released last month by the Centers for Disease Control and Prevention (CDC) found that 30.2 million Americans 18 years or older — 9.4 percent of the population — had diabetes in 2015.
Nearly a quarter of the people were unaware that they had diabetes, or didn’t report it during the screening.
The rate of diagnosed diabetes increased with age, with over 1 in 4 people 65 years or older having diabetes.
On top of that, 84.1 million adults — or 34 percent — had prediabetes, an elevated fasting blood sugar level that is not high enough to be classified as type 2 diabetes. Without lifestyle changes, people with prediabetes will likely develop the condition.
Only 11.6 percent of these people were aware that they had prediabetes.
Diabetes increases the risk of serious health complications, including early death, heart disease and stroke, kidney failure, vision loss, and amputation of toes, feet, or legs.
Rates for diabetes and prediabetes were also higher among Asians, African-Americans, and Hispanics.
Around 90 percent of people with diabetes have type 2 diabetes. This condition occurs when the body can no longer use insulin properly, which causes a buildup of sugar in the blood. Type 1 diabetes is an autoimmune disorder with genetic components and is not linked to poor diet or lifestyle choices.
Steady rise in diabetes through 2050
The diabetes problem has been a long time coming.
And although doctors, public health officials, and others are pushing hard to prevent more people from developing type 2 diabetes, they have their work cut out for them.
“I think people are only just becoming aware of the enormity of the problem,” said Dr. Elizabeth Murphy, chief of the Endocrinology and Metabolism Division at San Francisco General Hospital, and a professor of clinical medicine at the University of California, San Francisco.
“We’re just trying to slow down the increase, but I don’t think there’s any stopping it any time soon,” she added.
A 2010 study, published in the journal Population Health Metrics, estimated that between 20 and 33 percent of adults in the United States could have diabetes by 2050, either diagnosed or undiagnosed.
Researchers obtained the higher number by assuming that recent increases in the number of new diabetes cases would continue, along with a lower rate of deaths due to the disease.
As treatment for diabetes improves, people live longer with the disease. This increases the percentage of people in the population with diabetes.
The rise in diabetes cases over the next few decades will also be fueled by a growing number of older Americans, who are at greater risk of type 2 diabetes.
In the United States there will also be an increase in minorities, who are more likely to develop diabetes.
Cost of diabetes draining economy
Like other chronic health conditions, diabetes is a big drain on the American economy.
In a study published in Diabetes Care, researchers estimated that in 2012, diagnosed diabetes cost $245 billion in the United States.
Direct medical care accounted for $176 billion. Medical expenses for people with diagnosed diabetes were also 2.3 times higher than for people without diabetes.
Healthcare costs for diabetes and related conditions accounted for 23 percent of healthcare spending in the United States. More than half of this spending was a directly related to diabetes.
Diabetes also caused about a $69 billion drop in productivity in the United States caused by employees missing work, working less efficiently, being unable to work, or dying early as a result of diabetes.
Another study estimated that in 2007, undiagnosed diabetes cost the country $18 billion in medical care and lost productivity.
People with undiagnosed diabetes, though, may not be receiving the care they need to stay healthy, so their costs will be lower.
According to research by Healthline, if every American in 2015 with undiagnosed diabetes were diagnosed, the total cost for this group would be around $76 billion.
In addition, if all Americans who currently have prediabetes developed diabetes and were diagnosed, the total costs for this group would be $896 billion.
As the number of Americans with diabetes rises, so will the costs.
In a 2009 study in Diabetes Care, researchers estimated that annual spending related to diabetes will increase to $336 billion by 2034. About half of this would be Medicare spending.
This included only medical care for diagnosed or undiagnosed diabetes and related conditions. It also didn’t take into account inflation.
The researchers estimated that the costs would level off after this point as the number of newly diagnosed diabetes cases plateaus.
Rising diabetes costs fit with the expected increase in healthcare spending in the United States over the next two decades.
The Altarum Institute projects that U.S. healthcare spending will rise to around 20 percent of the gross domestic product (GDP) by 2030.
The OECD estimates that the U.S. GDP will hit $22.5 trillion that year.
Based on these numbers, diabetes care will account for about 7 percent of all healthcare spending in 2030.
Compare this to Healthline’s estimates for other diseases: cancer will account for 3.5 percent of healthcare spending in 2030, Alzheimer’s disease will account for 10 percent, and cardiovascular disease 25 percent.
The cancer estimate is based on healthcare costs for 2020, and the cardiovascular disease estimate is based on 2035 costs.
Stemming the tide of diabetes
On the surface, the solution to the rising number of diabetes cases in the United States is simple — eat better and exercise more.
“We know from the Diabetes Prevention Program study that lifestyle modification can reduce the risk of developing diabetes by 58 percent,” said Murphy. “And it’s not about going out and running a marathon. It’s losing 5 to 7 percent of your body weight, and exercising very moderately five times a week.”
The big question, though, is how do you get people to make those changes?
For this, many approaches may be needed.
Effective lifestyle modification programs — like the one used in the DPP study — can help people make the necessary changes to head off diabetes.
These intensive courses provide people with information on healthier eating and exercise, but also show them how to make these changes in their everyday lives.
Many employers already offer these programs to employees in order to reduce healthcare costs and improve productivity.
Starting this year, Medicare will cover the cost of lifestyle modification programs that follow the CDC’s curriculum.
Some states also provide incentives for Medicaid enrollees to participate.
These will help people change their lives, but broader approaches will also be needed.
“We know there are things that individuals can do by being part of these programs,” said Murphy, “but also things governments and cities can do, as well, to encourage the healthy behaviors.”
One option is soda taxes, which have been passed in Philadelphia, San Francisco, Boulder, Colo., and other U.S. cities, as well as in countries around the world.
In Mexico City, a sugar tax has led to two years of declines in purchases of sugar-sweetened beverages.
It will take longer to see what effect this has on the obesity and diabetes rates in the city, but health officials are keeping a close eye.
Many parts of the United States also need to improve the built-in environment in order to encourage people to get off their couches or out of their cars and move more.
“We know that in countries where walking and biking to work have lower rates of diabetes,” said Murphy.
This happens not just in underdeveloped countries, said Murphy, but also in developed countries “where the city is designed for biking and walking.”