Dr. Warren,
Thank you for your work and great question. My response pertains to independent research conducted in the U.S, along with global research on food, the food industry and health trends.
Having researched trauma and resilience for over 15 years, treated individuals across the lifespan as a therapist in addition to being a survivor of complex trauma, generational poverty and an eating disorder, I would say it's both and.
Two years ago I attended a national School-Based Health conference in DC. A nurse presented on improving proper use of insulin pumps among youth and teens. I was one of two or three clinicians in a room full of nurses. The presenter joked about the parallel of the ratio of nurses to social workers saying the way to get kids to use their pumps was to hire more therapists! She definitely believed the primary barrier to successful diabetes management was social-emotional health.
Recently I compiled data across several addictions and included obesity rates. Of all known, diagnostically supported addictions, tobacco and alcohol use were the two highest percentages. Beating both of those rates combined and then some was the rate of obesity which may or may not be the result of a disordered relationship with or 'addiction' to food. Because the DSM does not (cannot due to big pharma stakeholders and major food corporations; my theory) classify Binge Eating Disorder as an addiction, we are prevented from truly seeing and treating the behavior as such, despite diagnostic criteria practically shouting 'this is an addiction!'. Therefore when someone does not adhere to a medical plan to treat symptoms of obesity, which can include diabetes, it may be due to the fact that we're overlooking contributing factors like social-emotional health, trauma history, co-occurring mood disorders and the presence of dependence on processed food products to cope with a spectrum of those symptoms. How many studies do we need on the effects of processed sugar and dairy before we start accepting fact? Not to mention fast food branding lighting up the same parts of our limbic system as when we see a friend or relative. Cheap, heavily and strategically marketed processed food is the most readily available drug on the planet. And diabetes medications have become increasingly profitable. 9 billion in insulin sales for one company; not too shabby. Hmm? How 'bout that?
Don't take my word for it; investors are pretty excited: "The global anti-diabetic drug market is expected to witness significant growth during the forecast period. This growth is attributed due to increasing prevalence of diabetes and rising demand for oral anti-diabetic drugs. In addition, sedentary lifestyle, increasing the percentage of obesity, high-stress levels are considered as a major driving factor for the growth of oral anti-diabetic drugs market."
This headline is by far my favorite: Drug Companies Look to Profit from DSM 5 The article explains the exciting financial prospects for stakeholders in drugs that came out to treat Binge Eating Disorder (which may be habit forming, in case you needed another addiction). Two clinical trials were complete ahead of schedule so the drug was developed and tested just two months after the release of DSM 5. And again, how 'bout that?
In addition, consider the following factors as reasons why an individual may have difficulty managing diabetes:
- Food Insecurity and access; can the individual afford the prescribed food plan?
- Does kale taste as good as pizza? If not, what other resources for pleasure or comfort does the individual have access to? How might that answer impact the desire to make food changes?
- Family culture and dynamics: How does the family eat? What does the family eat? Why? And what are the potential consequences for the individual if they change or attempt to change their eating habits?
- Does the individual have co-occurring mood disorder or other mental health diagnosis; biological or as a result of trauma or both?
- What are the incentives or motivations for the individual in managing their symptoms? Is there a potential secondary gain for not managing their symptoms, such as; maintaining a relationship or connection, receiving care and attention from loved ones, receiving care and attention from medical providers, seeing the illness as a form of rest they had no other means to obtain?
- Rule out passive suicidal ideation
- Are there other co-occurring addictions such as alcoholism sometimes masked as 'functional' alcoholism. If so, what are the contributing factors to the addiction? Trauma? Stress? Loss?
Meanwhile, Overeaters Anonymous has been quietly prescribing a whole foods, sugar and white carb elimination diet along with the 12 Steps for over 30 years. OA welcomes people with any form of disordered relationship with food rather than waiting for science to prove why some of us have been in a life long love triangle with Ben & Jerry. We can advocate for awareness and change while empowering ourselves with knowledge and resources. Meaning, those of us struggling with any aspect of the human condition can always awaken to choice and discover new choices even if supermarkets never stop selling Sugar Smack.
World Peace offers the greatest profits of all.
Thanks again for your question and your work.