Good to see articles in the press on diabetes. Is this one available in the Burmese language?

When Nick Baker writes 'lifestyle' I read 'behaviour'. Health education campaigns will have little impact on diabetes as knowledge is necessary but not sufficient to change behaviour.

Sugar is the main culprit. Coca Cola is full of it. Three in one coffeemix and teamix are almost entirely composed of sugar. A sugar tax or a soda tax is a good idea. Thanks to WHO for recommending it.

It sounds like Dr Ko Ko wants millions of dollars to address diabetes. How would he spend it? What are the priorities?

Jamie

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Is Myanmar prepared to fight diabetes?
Nick Baker
Myanmar Times
Friday, 03 February 2017

Customers pack around tables that immediately fill as soon as they are vacant. Greasy chicken pieces and litres of Coca-Cola quickly appear and disappear.

A Western fast food meal like this – which was unthinkable here not that long ago – is set to become far more ubiquitous in the years ahead.

The recent easing of economic sanctions has seen the arrival of several fast food chains. A fledgling network of Pizza Huts, Lotterias and Burger Kings can now also be found.

But as the market continues to open and all sorts of culinary vices flow in, there has been almost no information or education for the general public about potential health impacts.

The result? A ticking time bomb for diabetes.

Diabetes is an incurable disease where the body’s blood sugar becomes too high.

The most common form – type 2 diabetes – is linked to lifestyle factors. It often results from excess body weight and physical inactivity.

Complications from diabetes can include kidney disease, blindness, foot amputation, stroke and heart disease. Lifelong treatment is required to prevent these.

According to the latest National Survey of Diabetes and Risk Factors for Non-Communicable Diseases, 2.5 million adults aged between 25-64 years have diabetes in Myanmar.

But diabetes expert from the Ministry of Health Professor Ko Ko is far more worried about another finding – that almost one in five people in that age group are now classified as pre-diabetic.

These are individuals who have high blood sugar levels and will likely develop diabetes without lifestyle changes.

This is bad news for a country which is steadily drifting towards diets with increased sugar, fat and salt.

“If we don’t work on prevention now, many of these pre-diabetic people will become diabetic within five years,” Professor Ko Ko said.

At the current rate, Myanmar looks set to follow a familiar path of other countries around Asia.

“Consistently, the prevalence of diabetes has increased rapidly in Asian countries when a more affluent lifestyle is adopted,” Professor Rob Van Dam from the National University of Singapore told The Myanmar Times.

He said the prevalence of diabetes in Malaysia is “among the highest in the world” while China and India are “the countries with by far the greatest number of persons with diabetes”.

Many local foods certainly play a role in these diabetes numbers. Walk down any Yangon street and you’ll see all kinds of snacks rich in oil and sugar.

But, as put by the American Diabetes Association: “It’s easy to eat an entire day’s worth of fat, salt and calories in just one fast food meal”.

And experts stress the need to target new varieties of junk food and fast food in a country like Myanmar as attitudes around these products are still forming.

It’s apparent when visiting a Yangon KFC that there is a certain prestige associated with eating at these new arrivals – despite the negative health impacts.

“The same has happened in countries such as Hong Kong, China and Singapore, where Western fast food … has high status,” Professor Van Dam

“[So] Myanmar is [now] in a stage where measures could be taken to limit … excess weight gain and thus prevent dramatic increases in diabetes prevalence taking place.”

What’s the next step?

There is little debate over the shifts that are needed.

According to the representative of the World Health Organization in Myanmar Dr Jorge M Luna, people need to “avoid fatty and sugar-rich snacks, exercise regularly and drink water instead of soft drink”.

But there is debate on how to bring this about at a large enough scale to avoid soaring diabetes rates.

Several experts advocate a moonshot-style, whole-of-government effort to promote healthy living.

“We need to develop … relevant legislation, regulation and taxation measures around unhealthy foods and beverages,” said president of the Myanmar Diabetes Association Dr Tint Swe Latt.

There should be “health education campaigns” and new school curriculum measures that teach young people about the importance of “healthy diet, physical activity and exercise”.

“This is obviously easier said than done,” Dr Tint Swe Latt admitted.

But government inaction today will likely be much costlier in the long run.

“Diabetes is a disease that can be a very large burden on the health care system,” Professor Van Dam said.

And, according to Dr Tint Swe Latt, diabetes is regarded globally “as one of the causes of poverty and a hindrance for national development”.

Professor Ko Ko said the effect may already be happening: “Most people suffering from diabetes now are of working age which affects the productivity of Myanmar and leads to more poverty.”

There is currently limited government-funded help available to those with diabetes and international assistance on prevention or treatment remains worryingly scant.

“There are no major donations from NGOs like the millions of dollars invested in HIV, tuberculosis and malaria programs,” Professor Ko Ko said. “It’s very difficult for us with such a limited budget.”

The Myanmar Times contacted several fast food and junk food companies that operate here with two specific questions: if nutrition information is available for customers and their upcoming role in the fight against diabetes.

Sim Kay Soon, general manager of Pizza Hut Myanmar’s operating company Jardine CM Restaurant Group Myanmar, advised customers to visit the US Pizza Hut website for health information – which is only available in English.

“We believe that all food can be part of a balanced diet with appropriate exercise,” Sim Kay Soon said.

A spokesperson for KFC Myanmar said that “we are continuously working to improve the nutrition profile of our food content by developing a variety of menu options that can be part of a sensibly-balanced diet.”

But it remains to be seen if statements like this will be enough to avoid a full-blown diabetes epidemic in Myanmar over the coming years.

http://www.mmtimes.com/index.php/lifestyle/24804-is-myanmar-prepared-to-fight-diabetes.html