Deadly connections: Diabetes, junk food, tobacco use and TB

Shobha Shukla, CNS (Citizen News Service)
The 2030 Global Goals for sustainable development have an important focus on health, and rightly so. The world has pledged, amongst other things, to end HIV/AIDS, malaria and TB by 2030 and also to reduce mortality from non-communicable diseases (NCDs) by 33%. Today, 387 million people are affected by diabetes mellitus (DM), with 77% of the cases in low- and middle-income countries (LMICs) where TB is highly prevalent. It is also interesting to note that the high TB and DM burden countries have a high burden of tobacco consumption too.

 Recent studies have shown that 16% - 46% of the people living with TB also have diabetes, and many are unaware of it. With more than 9 million cases of TB each year, the convergence of these two diseases threatens to become a major public health crisis, and at the same time raising the spectre of a devastating impact on TB control.

Global statistics suggest that tobacco smoking is one of the significant risk factors for TB as well as for diabetes. If we really want to eliminate TB, we will have to eliminate tobacco and control diabetes, said Dr Tara Singh Bam, Regional Technical Advisor (Tobacco Control) at the International Union Against Tuberculosis and Lung Disease (The Union), in an interview with CNS (Citizen News Service). According to him, the goal should be to improve overall health of the person and tobacco control should be one of the key components of any public health intervention.

To eat or not to eat

Nutrition plays a very important role in both diseases. While over and improper eating raises the risk of DM, under/malnutrition makes a person more prone to TB infection. Dr Anil Kapur, Chairman World Diabetes Foundation (WDF), spoke at length with CNS on this crucial issue.

"This may indeed present a confusing situation not only for people suffering from both TB and DM, but also for the doctors treating them. “When we talk to TB patients about nutritional advice, we ask them to eat well so that they can put on weight - up to a certain level, body weight protects against TB. In DM it is the other way round - one has to keep weight under check. This is a conundrum we need to focus attention on. But basically the advice is about healthy eating - consuming optimum amounts of proteins, carbohydrates, fat,” says Dr Kapur.

The changing food habits of people, along with sedentary life styles, are adding fuel to fire.

Dr Kapur points out that as food habits of even urban slum dwellers are changing for the worse, incidence of DM in them is increasing. Even low income groups are patronising biscuits, breads, chips, cola drinks in a big way. “I have an issue with the government’s political gimmick of selling rice at very cheap rates. 80%-85% calories of people are coming from this polished rice which is making them more unhealthy. By distributing biscuit packets to school children under the garb of feeding them we are actually making them vulnerable to many diseases. Undernourished children when given this type of food, are really harmed. Then again, when people see their favourite film stars advertising for cola drinks on TV, it becomes aspirational for them to covet the same. The eating out culture is also driving us to consume more unhealthy food,” feels Kapur.

The way forward

We need action at the policy as well as community level. Dr Anthony Harries, Senior Advisor and Director, Department of Research at The Union told CNS that the governments should take regulatory legal action around the issue of healthy diets, like increasing taxes on cola/sugary drinks, to make people less inclined to buy them.

“We need to bring about sanctions against the  food industry or sign up to a package like the WHO's MPOWER package. WHO, being a global health agency, needs to take some action on this front on the lines of the Framework Convention for Tobacco Control. If we just concentrate on trying to nudge people away from a lifestyle fed by the industry, it will be an uphill struggle to control DM and hence TB. When Dr Tom Friedon, Director CDC, was Health Commissioner in New York he showed that if you tackle legislation, if you tackle the size of food portions and drinks, put calorie content on to menus, increase taxes, it has immense benefits for public health.”

Dr Bam echoes similar sentiments. “If we are really serious to achieve the global target to reduce NCD related deaths, we must be serious to regulate all junk food, alcohol, tobacco. Tobacco control framework is a very comprehensive one about how to tackle the tobacco industry and integrate tobacco control in public health systems. A somewhat similar framework needs to be applied to regulate, monitor and control the food and beverage industry too”.

Dr Kapur too agrees that the food industry has a pivotal role to play in the fight against DM and TB. “The question is do we want to regulate the food industry or do we want to set standards for it to comply with. The more regulated environment we get into, more are the chances of a push back. But then, without regulations, the industry may not play according to the rules. So we have to find the right balance. As more and more evidence accumulates about the harms of packaged/processed food, the industry will have to change. We can help that process by allowing them the time and space to do so, at the same time nudging them forward to produce more healthy options. There needs to be a dialogue on this and the government will have to step in and play an active role. There have been some good developments like food labelling becoming mandatory in many countries. But it has to be much more transparent than what it is now. Very often the public does not know the meaning of terms used and the industry hides behind this ambiguity. I think food should be colour coded to classify it as healthy and not-healthy food”.

At the community level, Dr Harries feels there needs to be more awareness and education—what is good and what is not good for your health. But this is easier said than done. We have to reach out and deliver simple messages repeatedly to people. So proper and impactful communication strategies are needed.

Dr Harries also wants school nutritional programmes to be looked into. “We did that in Fiji as part of an operational research and it did improve the quality of food available in schools, bringing down obesity levels in children over a period of time. Urban planning should encourage walking and use of public transport, which is not happening in India. We need to have walker friendly cities. We have think about how to get people to exercise more in the limited space available. We have to do the right things and also evaluate/measure the impact of our interventions”.

Agrees Dr Kapur that the public has to be made more aware about the consequences of eating junk food. If people cut down buying food that is not healthy, obviously the industry will not have any economic incentive to produce it.The reason why unhealthy food becomes popular is because it is cheap, tasty and convenient.

“The eating-out culture is also driving us to consume more unhealthy food. With both parents working, cooking at home has taken a beating. Eating unprocessed, freshly cooked food is becoming an exception, rather than the rule. We have to prevent that from happening. We need to teach our children the joy of cooking simple things at home and making it pleasurable for them. Cooking at home should not be a chore but an exciting and happy daily event, in which all members of the family take part”, advises Dr Kapur.

The recent Bali Summit on TB and diabetes, hosted by The Union and WDF, under the patronage of Ministry of Health of the Indonesian Government also stressed that building a worldwide campaign against DM-TB, fostering new partnerships and developing innovative interventions can act as a game changer in this fight against communicable and non communicable diseases. 

Shobha Shukla, CNS (Citizen News Service)
5 November 2015


  1. what is the connection between tb and dm please? is it that those who have tb are prone to dm or vice versa?

    1. Both are true - diabetes, TB (and tobacco use) have a deadly linkage