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jeudi 2 février 2012



Two medical Journals in my field have published socially related articles. Normally a rare phenomenon!
Food Insecurity is when you cannot afford good food or you do not have access to good food. For those of us working with poor Americans, it had been evident that most of the poor Americans (more than half of them) lived in what can be termed food deserts that is no fresh food is available for a ten-mile radius.
Those with food insecurity have lower indices of health and in patients with Diabetes, the control is poorer with food insecure patients, contributing to their inability to follow the diet prescribed for them, not to mention the stress related to own inability to follow good diet, knowing what it will do to their health. So it might be good idea to ask a patient, before giving advice on what to eat, whether or not they have the chance to eat what you are prescribing or the ability to eat or the means to procure it.
It may not come as a surprise to you that most doctors working with the Indians in the USA are not aware of the fact that the majority of Indians have food insecurity.
I am sure that the situation is similar in India, Malaysia and Cambodia: the three countries I will be visiting in the coming months.
The article is even more thought provoking, and of equal importance. They were able to show that increased levels of cortisol can influence ones choice of food, those with higher cortisol levels tend to choose less nutritious items.
Burnout, trauma, stress, higher adipose tissue all can raise cortisol levels in the humans, among other causes and once again we come back to the poorer sections of the social spectrum. It may be the mechanism of central adiposity in stressed patients
It is not that the poor suffers from all chronic diseases but certainly they live under conditions that promote chronic disease. So treatment of the disease is less good for the society than the prevention of these diseases.

But you would be sad to know that in the USA 95 per cent of the money spent on health care goes on treatment and only 5 % goes to prevention. In other countries it can be no different either: especially the new economically rising countries such as BRIC…..

Food Insecurity and Glycemic Control Among Low-Income Patients With Type 2 Diabetes
Seligman et al   UCSF  Diabetes Care February 2012
Endocrine. 2012 Feb;41(1):76-81. Epub 2011 Oct 9.

High cortisol levels are associated with low quality food choice in type 2 diabetes.

Brain, Obesity and Diabetes Laboratory (BODyLab), New York University School of Medicine, 145 East 32nd Street, 8th Floor, New York, NY, 10016, USA

Opportunity in Austerity — A Common Agenda for Medicine and Public Health

Nicholas W. Stine, M.D., and Dave A. Chokshi, M.D.
N Engl J Med 2012; 366:395-397February 2, 2012

The above articles were published in February 2012.
Compare this with something I wrote in 2000!
Photo of RioYumuri, Baracoa, Cuba

Anxiety regarding the supply of Food as a cause of Obesity
The Republic of Cuba, then under the tutelage of Fidel Castro Ruz and with material assistance from the
previously socialist governments enjoyed one of the highest health indices in the world. With food available, by ration cards and at subsidized restaurants, the average Cuban intake of food calories with proportions of carbohydrate, fat
and protein was adequate. Impressions of visitors to the island at that time and health statistics support he fact that the Cuban people were in general fit and lean and less obese than other Caribbean islanders (far less obese than their brethren in Miami).
The fall of soviet System and the continuing blockade of food supply to the island by US Government could
not offset the liberalization by the Cuban State aimed at increasing food availability. A panic regarding food availability that set in the early years of this "special period" has continued to this day. Like in the other countries of the American continent, the easily available food- Pizzas, Fried Foods- is not as nutritious as the food that was available before.
Compounding this inadequacy in quality, the anxiety about food availability has increased the amount of calorie intake.
The combined result-increased quantity of less nutritious food and anxiety-obesity has become a problem in the island with rapid, subsequent increase in concomitant diseases such as Type 2 Diabetes and Heart disease. That it should occur so rapidly- less than ten years after the dissolution of the USSR is reminiscent of other groups of people. Among them the hunters and gatherers in North America, deprived of known supplies of food by encroachers, developing a generational anxiety about the supply of food provided with insufficient and unhealthy food and suffers similar subsequent corporeal ill health.