As our lifestyles move more and more toward "digital this� and "remote that�, we have redefined our phenotypes without genetic manipulation, simply by excess consumption combined with inactivity. Increasing inactivity and greater access to food, is creating multiple health issues, which revolve around obesity. Everywhere you turn there seems to be an offering of an assortment of calories. Donuts and tacos seem to have integrated into meeting agendas. Birthday celebrations, anniversaries, and every official holiday party, center around kitchens or some sort of food preparation. We are literally surrounded by food and in large portions. A family function or a social gathering does not exist without a sampling of calories. As a result, we no longer eat when we are hungry but eat out of habit.

• Obesity is a major health problem in South Texas and its prevalence only continues to rise.
• National Health and Nutrition Examination Surveys from 1999 to 2002 have determined that 65% of the American population is overweight or obese.
• In 1991 only four states had an obesity (BMI greater than 30) prevalence of 15% to 19%, and no states had greater than 20%.
• In 2005 only four states had an obesity prevalence less than 20%, and three states had an obesity prevalence greater than 30%. South Texas (specifically Bexar County) was in the spotlight or dark side of these figures in the past several years by exceeding that percentage.

Unfortunately, more bad news is soon to come. We have all heard of cause and effectÂ…yes? Obesity is only the cause; the effect is some thing much more devastating.

• Obesity increases our risk of cardiac events and strokes, between two to four times, compared to those where it is absent.
• Obesity is the number one cause of blindness in this country.
• It's the leading cause of non–traumatic lower extremity amputations and end stage renal disease.
• Obesity before age 35 reduces our life expectancy by 22 years.
• The most unfortunate figure is that we all know someone who has Diabetes, maybe it's you. The American Diabetes Association and Texas Department of Health have determined that of the 1.5 million people living in Bexar County, over 200,000 have diabetes. There is no questioning the relationship between obesity and diabetes. There is a
• direct correlation.
• There are two types of diabetes and it's necessary to clarify that all of this data refers to type 2.
• There are multiple risk factors for the development of diabetes mellitus type 2; age over 45, BMI greater than 26, a relative with diabetes, being of African American, Asian American, Pacific Islander, American Indian, and Hispanic of Mexican or Puerto Rican descent.
• Other risk factors include a history of gestational diabetes, a blood pressure of greater than 140/90, an HDL less than 35, Triglycerides greater than 250, and of course inactive lifestyle.

The diagnosis of diabetes type 2 is made via laboratory testing. A fasting blood sugar of less than 99 is normal, a glucose between 100 and 125 is considered to be a pre–diabetic state, or more precisely identified as impaired glucose tolerance. Diabetes is considered present if the fasting glucose is greater than or equal to 126. The absence or presence of diabetes seems quite clear but what exactly is impaired glucose tolerance? Well, thanks to works by Dr. Ralph DeFronzo, it was determined that type 2 diabetes is not the absence of insulin, at least not in the early stages, but just the opposite. Due to a condition called insulin resistance, the body actually makes greater than normal amounts of poorly functioning insulin that leads to elevated glucose levels which ultimately increase pancreatic failure, and are not quite high enough to be considered diabetes.

The test that best defines an individuals risk or identifies one as diabetic is the glucose tolerance test which challenges the endocrine system by challenging the pancreatic response to an oral challenge of 75 grams of glucose, and monitoring the response at one and two hours. A glucose of less than 140 is considered normal. A glucose of 140 to 199 is considered impaired glucose tolerance, and greater than or equal to 200 is overt diabetes.

• Treatments for diabetes include a multidisciplinary approach.
• They should always include diet and exercise. The management and treatment of the whole metabolic syndrome which include blood pressure, lipid management, and preventive foot and eye care.

Diabetic medications include several classes of medications: The older meds that stimulate insulin secretion, others that inhibit starch breakdown to sugar after absorption, others decrease insulin resistance, and some improve pancreatic function, reduce gastric emptying and reduce the livers production of glucose despite high glucose levels. There is of course a myriad of insulin and insulin combinations, of varying duration's, and routes of administration including inhaled insulin for appropriate individuals. The best treatment combination should be decided in consultation with a physician.

It is important to destigmatize insulin therapy. As we develop diabetes at younger ages the likelihood of needing insulin therapy is quite high. Old wives tales told of undesirable effects of insulin. In all probability it was temporally coincidental that as individuals reached stage III of diabetes, the point of need for insulin, that the complications of diabetes were also becoming manifest. It has been clearly demonstrated in multiple studies that the most important variable in reduction of diabetic complications is tight glycemic control with glucose's as close to normal. The tests for monitoring glycemic control include HbA1C, which are three month averages and finger sticks pre and post meals (as indicated by type of diabetes and control).

If there were only one take home message to this synopsis, it would be to review risk facts mentioned above and get testing if indicated. Diabetes, if detected early, may delay complications, retard pancreatic decline, and improve quality of life.

Dr. Raul E. Gaona, Jr. adds, "Remember, your health is controlled by you and knowledge is power. Establish a good lifestyle plan while maintaining an honest relationship with your doctor(s). 'Think Healthy & Be Healthy.'"