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mardi 22 février 2011



The recently released information on Obesity rates in America and also the rest of the world, serve the troubadours of the tragedy, who herald a worse disaster to come.

Conveniently, these writers who generally have no contact with the patients or society they are studying, prognosticate these disasters based on their calculations of what is to come?

What was before? How did it get here? They would dismiss it all by saying: Life Style Changes and Socio Economic Factors or Eat more fruits and vegetables and Exercise more..

Just yesterday I read in the Jamaica Gleaner (February 21, 2011) newspaper, a comment by a visiting doctor to Ocho Rios:

Said Dr C: "Potatoes, yam, rice, and bread are sources of starch, which can cause sugar in the blood, and there seems to be a high concentration of those foods among Jamaicans. They need to eat more fruits and vegetables."

Someone ought to tell this visiting doctor from the sterile Midwestern part of the USA that the Jamaicans have always been eating these, but the Diabetes is a recent phenomenon among them.

You can be sure that the person who uses these catch phrases are usually trained in Statistics or some other very quantitative Branch, including specialties in Medicine which deal with only one organ such as the Eye and it is extremely rare to meet one of these researchers who is educated in Social Sciences such as Psychology, Sociology and especially Anthropology.

If you ask these mavens, what does socioeconomic factors mean, they would shuffle their papers and come up with a graph: Job and Income, or the all encompassing term, Poverty. Of course, allele deletions in Genetic material would crop up as a cause of Obesity, the Scientists who have studied the Pima Indians have been trying for more than 25 years to find a genetic cause of the obesity, but their output of papers on social and environmental factors that cause obesity among the Pima can be counted in one hand among the thousands of their quantitative output.

The same applies to Life Style. Because these clichés often excuse the researcher in their virtual world or the doctors and nurses confronting patients. When asked for an explanation of their tragic predictions, they can hide behind these words, which most of them cannot explain in a legitimate and legible fashion.

At a time when only Native Americans had high prevalence of obesity and Diabetes, it was blamed on the Tribal Life Style; when the entire nation now has a problem with obesity and Diabetes, now it is blamed on the National Life style. India has become the capital of World Diabetes, and it is blamed on Life Style changes since Economic reform of 20 years ago.

25 per cent of the new onset Cardiac Diseases including Myocardial Infarction occurs in people under the age of 40 in India. Indians with Heart Disease, may be vegetarian, walk a lot during the day and may have less cholesterol circulating in their blood and may be free of Diabetes.

These are the characteristic of Life Style changes the doctors advocate in the west, so what advice can we give the Hindou vegetarian active thin patient of 40 with his first heart attack? Eat Better? More Exercise? The most commonly used mathematical equation of Life Style Changes used by doctors and nurse educators in the west. Is this mantra: eat better and exercise more…

The words, Life style changes, also continues the old tradition of accusing the sufferer.

The term I would like to introduce is Quality of Life.

My Lifestyle did not change: Travel, Eating Out, Socializing with friends, attending lectures to give some examples, when I transiently move from Miami to Havana, but the quality of my life is certainly improves; this is also the case when I am in Kuala Lumpur.

This thought came to me, while I was sitting in a café, sipping a glass of wine, reading or shall I say re reading the excellent travelogue by the best travel writer in the English language, Norman Lewis. I was enjoying the spring like weather on this early February afternoon in Paris, near Chatelet.

Now I have to talk about this concept with my friends and colleagues, so the first person I wrote to was JK, an American teacher currently working abroad who is very keen on Yoga and its effects upon the body.

Her response arrived quickly and I quote her:

That's interesting, the difference in connotation between Quality of Life and Lifestyle. How do we define each term depends on the culture from which we come... How we prioritize these ideas in our overall habits is yet another topic ...

From the perspective of a patient, I think "Ways to Improve Quality of Life" sounds more appealing (beneficial, easy) than "Changing Your Lifestyle" or "Lifestyle Tips". It's less daunting and it appeals to a sense of easy betterment.

So here is one Explanatory Model. We must do what the patient wants and is able to do, to better their lives, not preach to them what we as health care providers think is necessary.

To be continued.

PS: i had written the above a week ago and today in the mail, I received this protocol for improving quality of life of patients with Diabetes from a group of psychologists in Netherlands with the hope that psychological intervention would improve diabetes care.

Step in the right direction I would say! added on 28th february 2011

Testing the effectiveness of a mindfulness-based intervention to reduce emotional distress in outpatients with diabetes (DiaMind): design of a randomized controlled trial

Jenny van Son email, Ivan Nyklicek email, Victor JM Pop email and Francois Pouwer email

BMC Public Health 2011, 11:131doi:10.1186/1471-2458-11-131

Published: 24 February 2011

Abstract (provisional)


Approximately 20-40% of outpatients with diabetes experience elevated levels of emotional distress, varying from disease-specific distress to general symptoms of anxiety and depression. The patient's emotional well-being is related to other unfavourable outcomes, like reduced quality of life, sub-optimal self-care, impaired glycemic control, higher risk of complications, and increased mortality rates. The purpose of this study is to test the effectiveness of a new diabetes-specific, mindfulness-based psychological intervention. First, with regard to reducing emotional distress; second, with respect to improving quality of life, dispositional mindfulness, and self-esteem of patients with diabetes; third, with regard to self-care and clinical outcomes; finally, a potential effect modification by clinical and personality characteristics will be explored.


The Diabetes and Mindfulness study (DiaMind) is a randomized controlled trial. Patients with diabetes with low levels of emotional well-being will be recruited from outpatient diabetes clinics. Eligible patients will be randomized to an intervention group or a wait-list control group. The intervention group will receive the mindfulness program immediately, while the control group will receive the program eight months later. The primary outcome is emotional distress (anxiety, stress, depressive symptoms), for which data will be collected at baseline, four weeks, post intervention, and after six months follow-up. In addition, self-report data will be collected on quality of life, dispositional mindfulness, self-esteem, self-care, and personality, while complications and glycemic control will be assessed from medical files and blood pressure will be measured. Group differences will be analysed with repeated measures analysis of covariance. The study is supported by grants from the Dutch Diabetes Research Foundation and Tilburg University and has been approved by a medical ethics committee.


It is hypothesized that emotional well-being, quality of life, dispositional mindfulness, self-esteem, self-care, and blood pressure will improve significantly more in the mindfulness group compared to the control group. Results of this study can contribute to a better care for patients with diabetes with lowered levels of emotional well-being. It is expected that the first results will become available in 2012. Trial registration: Dutch Trial Register NTR2145.

NB regarding Jamaica, I found this article from 1958 from the Medical Research Institute's Metabolism Research Centre at the University of the West Indies in Kingston..."fed on a low-protein, high-carbohydrate diet
designed to simulate that eaten by poor people in Jamaica."