“Dis-moi ce que tu manges, je te dirai ce que tu es.”
“Der Mensch ist, was er ißt.”
High school lessons failing you? OK, here are the translations: “Tell me what you eat and I will tell you what you are” and “man is what he eats.” The English version of this phrase actually doesn’t appear until the 1920s when an advert for beef claimed: “Ninety per cent of the diseases known to man are caused by cheap foodstuffs. You are what you eat.”
The advice to eat well is clearly from way before a butcher’s advert in the Bridgeport Telegraph. As far back as 400 B.C., Hippocrates, the father of medicine, had a missive: “Let food be thy medicine”. But with about 50% of all deaths coming from heart disease, stroke or Type 2 Diabetes in the US—and 80% of all chronic conditions attributed to poor diet, lack of exercise, smoking and too much alcohol consumption—it is clear we either don’t get the message or don’t know what to do about it.
Part of the problem is that “good” food often looks expensive relative to the cost of “bad” food. Some studies show that organic food can cost between 20% and 100% more than its mass-produced cousins. Even high quality but mass produced and healthy pre-packaged meals cost between $5 and $10 compared to all you can eat buffet at Luby’s for $5.99.
So, while we know we need to eat better, it can be a hard choice for many people if all you look at is the cost of food. But what you eat costs you more than the grocery bill.
Cost of Diabetes
According to the latest (2014) estimates from the CDC, 29 million people, or 9.3 percent of the U.S. population, have diabetes. Type 1 diabetes affects just 5 percent of those adults, with type 2 diabetes affecting up to 95 percent. Type 1 diabetes is an autoimmune disease — the body’s immune system attacks the cells in the pancreas that make insulin. Type 2, where some people have inherited genes that make them susceptible, is fundamentally a result of lifestyle choices, of obesity and inactivity. The CDC also reports that 27.8% of people who have diabetes are undiagnosed.
The medical costs of this are enormous. The direct medical costs of treating diabetes and its complications, during a lifetime, in the United States ranges from around $55,000 to $130,000, depending on age at diagnosis and gender, with the average being $85,200. Collectively, this cost was $176 billion in 2012 according to the CDC. Indirect costs (through disability, work loss and premature death) predicted to be an additional $70 billion. With the alarming growth in diabetes in the US, the combined costs will today be way over one quarter of a trillion dollars.
While these sums mean a lot to a healthcare provider or insurance company, the question is whether they mean anything to someone paying a monthly health insurance premium or no premium at all. If you are paying a portion of your premiums and any sort of co-pay, then then these costs definitely mean something to you. According to the American Diabetets Associaation, for those diagnosed with diabetes, they incur average medical expenditures of about $13,700 per year. Of this amount, $7,900 is attributed directly to their management of diabetes. Combined that means their medical costs are 2.3 times those without diabates.
Assuming you buy your medication and check your blood sugar levels with your glucometer, then you are paying between $60 and $400 plus a month – depending on your insurance and co-pays. These expenses also do not cover any other costs associated with blindness and eye problems, kidney disease, nerve disease, non- alcoholic fatty liver disease, periodontal (gum) disease, hearing loss, erectile dysfunction, depression, and complications of pregnancy, among others. All of these cost patients time and money to manage and live with.
Clearly, what you eat can cost you a lot more than what you pay for your food.
Quality of Life
In the US, over 70,000 people a year have a limb amputated as a result of diabetes. That’s one every 8 minutes of every hour of every day of the year. Even if you don’t have to pay for that amputation, you end up paying with your quality of life. These costs are harder to quantify, but no less real. These are opportunity costs (or quality of life issues) that obese and diabetic people face every day.
According to the American Diabetes Association, having diabetes is a “demanding disease.” Here is what they say:
“Managing your diabetes can be stressful. The way you feel when your blood glucose levels are low or really high adding to the stress. On top of that, there are the worries that you might develop complications, and the burden of dealing with any complications you may already have. It is no wonder that many people feel that diabetes affects their quality of life.”
So, what makes up quality of life? Psychologist Richard Rubin PhD, says that diabetes can feel overwhelming and can affect many parts of your life.
- Physical symptoms like fatigue or the pain of neuropathy
- Mental symptoms such as depression over lost health or fear of future complications
- Diabetes can take away things that make your life enjoyable, such as eating what you want, or driving, or sex
- You may find yourself having less physical affection, including fewer hugs, if you don’t make contact a priority
- Relationships, finances, and work issues all affect quality of life and are affected
- And there are bigger issues, like: What am I doing with my life? How am I still contributing? Am I enjoying life anymore?
One of the hardest pieces is the burden of diabetes management. William Polonsky PhD, Director of the Behavioral Diabetes Institute, says, “Many people become overwhelmed, frustrated, or ‘burned out,’ by the daily difficulties of diabetes and by the unending, often burdensome self-care demands, potentially leading to anger, guilt, depression, fear, feelings of hopelessness.” This condition is sometimes called “diabetes distress.”
But how do you put the these costs into your weekly budget?
One way is to look at the opportunity cost of your life. How many hours a week do you spend managing, worrying about or dealing with diabetes? Now, how much is an hour of your time worth to you? (Look at how much you earn net each week and divide by the number of hours you work).
This is the cost of what you eat and the decisions you make about how much you exercise.
In 2007 Newsweek asked the question as to whether diabetes was a disease of poverty?
Researchers show that for men, being in the lowest-income doubles the risk of developing Type 2 diabetes compared to being in one of the highest-income brackets. Additionally, researchers found that living in poverty in the two years prior to diagnosis increased the risk of developing Type 2 diabetes by 24 percent, a risk not changed when factoring in weight or physical activity.
So, it may be fair to say that diabetes, like many lifestyle conditions, seems to afflict those who can least afford to pay for the products and services that might help them out of their health spiral. Additionally, while it may be politically incorrect to say so, many of these same people pay little or nothing for their healthcare and so they do not live with direct cost implications.
It is hard to quantify the costs of life-style decisions when people don’t directly pay out of their pockets for the impacts of those decisions. If your premiums and co-pays were $300 more a month for those that don’t eat well and exercise, then many of those people would eat better and exercise more. But this is hard to inflict on the poorest people in our community.
The risk of death for adults with lifestyle diseases like diabetes is 50% higher than for adults without it. Unless we can get people to transform how they think about their lifestyle decisions and the indirect cost they are causing themselves, the health care system, and society as a whole, it is hard to see any of this changing.