SINGAPORE: Last week, Prime Minister Lee Hsien Loong highlighted that Singapore must “go all out” to fight diabetes in his National Day message.
He said a big reason for ill health in old age is diabetes, with almost a third of those over 60 having this disease. “At first diabetes is an invisible disease, but over time its consequences are severe – blindness, heart disease, kidney failure (and) amputated limbs.”
Each one of us must take responsibility for our own health, and this must start from young, he said. While there are good doctors and hospitals, it is better for people to stay healthy and not go to one, he added.
Mr Lee’s remarks have gotten Singaporeans wondering, what is it about diabetes that makes it so serious it winds up in the Prime Minister’s National Day message? And if Singapore’s diabetes problem is serious, does that mean that the personal precautions we each take are not enough?
SINGAPOREANS PARTICULARLY VULNERABLE
For many, diabetes used to be regarded as a rich person’s disease and occurred mostly in older adults.
This is no longer the case, at least in Singapore. People in Singapore are developing Type 2 diabetes at a younger age.
Even pregnant women are not spared. Our nation has among the highest rates of gestational diabetes globally, a condition that predisposes mothers and their offspring to greater risk of developing Type 2 diabetes postnatally.
It is recognised that our modern lifestyle and eating habits are primary causes, but why are we particularly vulnerable?
It may be because we have the luxury of abundant, easily accessible and mostly affordable food when eating out – and perhaps too many options, which can sometimes overwhelm and lead us to eat indiscriminately.
It is often much too convenient to “ta bao” and grab something on-the-go, whatever available and satisfying, without much thought to the nutritional quality of the food we eat and its long-term health implications.
For some, calorie-rich foods like chicken rice and nasi lemak, which were in the past enjoyed only during celebratory occasions, have become an everyday affair.
Technology is a double-edged sword. Thanks to food delivery services and online shopping platforms, we now have increased convenient access to food, our daily needs and wants.
Yet, have these at-your-doorstep services translated to missed opportunities for physical activity?
One would hope that time saved from employing these services translates into more time and opportunity for regular exercise. Based on the 2010 National Health Survey, a large proportion of Singaporeans remains physically inactive.
How do we begin to battle this insidious disease, which occurs with little or no outward signs, yet when it hits and if poorly controlled, can lead to complications that significantly affect our quality of life with potentially alarmingly high costs?
WATCH WHAT YOU EAT
There has been much ado about reducing the amount of white rice and starchy carbohydrate consumption to reduce our risk of diabetes. Research evidence shows that high intake of white rice is indeed associated with a modestly higher risk of Type 2 diabetes, but it is important to realise that other dietary factors are equally important.
While it will benefit many Singaporeans to consume less white rice and noodles, a pertinent point is what these starchy foods are substituted with.
Rather than avoiding all refined grains or imposing strict restrictions on specific foods, recommendations are moving towards improving the nutrient quality of our diet within the limited amount of calories we should consume.
This means replacing refined grains with nutrient-rich whole grains, lowering intakes of red and processed meats, and opting for non-tropical vegetable oil instead of palm, blended oil or animal fat.
This also means increasing the consumption of vegetables and fruits, which not only provides a wide range of vitamins, minerals and phytochemicals, but also helps bulk up the meal to increase satiation.
In essence, this goes back to the age-old phrase of having a balanced diet.
Being mindful of what we drink – sugar sweetened beverages, fruit juices, sugar added to coffee, tea or malt drinks – will also make a big difference.
Liquids tend to induce less satiety than solids, which can often result in the overconsumption of calories and lead to excess weight gain and higher risk of Type 2 diabetes.
Even consumption of one can of soft drink each day has been linked to a substantially higher risk of Type 2 diabetes.
People are sometimes put off by the thought of exercising or being physically active, as they perceive it to be hard work. In actual fact, being physically active can be fun and be done in a variety of ways, including brisk walking, biking, tai chi, zumba, and even household chores.
Doing moderate intensity physical activities like these for at least 30 minutes each day, even if these are done in a few blocks, is generally recommended.
The key goal is to get more active and make this a fixed habit in your daily routine. Even walking briskly to the MRT station or mall or taking the stairs instead of the lift each day can make a difference.
Taken together, making wise food choices and being more physically active can help prevent excessive weight gain as well as protect ourselves from other lifestyle related diseases such as obesity, heart diseases, stroke and colon cancer.
It is increasingly recognised that these lifestyle approaches are the same factors contributing to better mental well-being and lower risks of depression and dementia.
Fostering healthier food preferences and promoting behavior to fight obesity during pregnancy and childhood can have long-term consequences on health, as they set the foundation for later food choices and the establishment of lifelong habits.
This speaks to the importance of optimal nutrition from pregnancy to appropriate parental feeding practices and role modelling of healthy lifestyles to children from an early age.
As individuals, we are not alone in our preventive efforts. The value of government initiatives, such as the Healthier Dining Programme and the creation of more park connectors and bicycle lanes, to support a healthier food environment and one which promotes more physical activity cannot be underestimated.
Admittedly, more work needs to be done to make healthy living a norm in society.
An important starting point will be for people to rethink their daily choices and make the conscious decision to take the next step towards healthy living.
Assistant Professor Mary Chong and Associate Professor Rob M van Dam from the Saw Swee Hock School of Public Health at the National University of Singapore are also members of the National University Health System. Mary is also principal investigator at the Singapore Institute for Clinical Sciences and Clinical Nutrition Research Centre at A*STAR.