Diabetes and me: The game, not the player

Writing about money for diabetes and me last week got Megan Whelan thinking: why is this all so hard?

As people work longer and harder, it decreases the bandwidth they have to do things like cook from scratch.
Photo: RNZ / Rebekah Parsons-King

I ate chicken nuggets this week. I needed to make room in my (tiny) freezer for my morning smoothie berries, and I had already thrown out several manky bags of frozen peas and tidied up the many iceblocks my forward-thinking flatmate keeps on hand for if we get Covid. I decided I would cook the nuggs.

As food goes, they weren’t terrible. Relatively high in protein, some saturated fat and probably more sodium than would be advised. They were also pretty cheap, fast, crispy and tasty. I’ve been thinking about this since last week’s column

I spoke to Boyd Swinburn, Professor of Population Nutrition and Global Health at the University of Auckland. He is an endocrinologist and now focuses on the public health aspects of obesity and diabetes.

Boyd said with disadvantage comes a range of risk factors for diabetes. People often leap immediately to, for example, thinking that fruit and vegetables are expensive. And that’s true, but it doesn’t cover the gamut of things that people might be struggling with.

“Over the last 30 or 40 years or so, as we have had increasing income disparity, wages have not kept up with costs. And so, people who are on a wage income have been progressively finding themselves more and more disadvantaged relatively and that means that they are having to burn more time to do two jobs or work more hours, to keep up household income, just to keep their heads above water.”

Professor Swinburn asked me if as well as calculating how much money I am dedicating to my health, I had also done the math on my time. As people work longer and harder, it decreases the bandwidth they have to do things like exercise and cook from scratch. And even if you can manage it regularly, what happens when things go wrong?

“Things are turning to custard like you’re losing your job, or you’ve had a Covid-19 lockdown, or the rents are climbing, or the cost of food is climbing, or the kids are not doing well at school. The car’s broken down and needs repair. Being poor is very expensive.”

All those things mean the mental effort to focus on one’s personal health comes well down the to do list.

“Because you’re swimming against the tide. The local environment, what’s easy, what’s available, what’s marketed, what’s cheap, what’s hyper palatable, are all the things that are not so good for you.

“To swim against that tide actually takes quite a bit of effort. People that have money, have resources, are able to commit to that because they have that luxury, but a lot of people don’t and therefore to swim against that tide and environment that’s not helping you is a tough job.”

Professor Swinburn had a strong reminder for me. I might be doing OK right now, but can I keep that up when things go wrong?

“When you’re first diagnosed with diabetes … it was probably a bit of a shock to you and then there’s a whole lot of things you need to learn and there’s probably quite a bit of motivation. But then you think, ‘okay, I can kind of keep this going.’ But you’ve got to do this for the rest of your life. That’s quite an energy sapping thought.”

It really is. And I am regretting those chicken nuggets now. But if I am living in an environment where “the easy choice is the unhealthy one”, as Professor Swinburn said, how can I keep this up? The answer: hate the game, not the player.

“Forty per cent of our diet is made up of ultra-processed foods created in factories, with multiple ingredients, including a whole lot of salt and sugar and fat and additives and so on. Those things are … specifically designed to be hyperpalatable . And we think ‘that’s nice’ and you don’t stop til you get to the bottom of the Pringles can because it’s been specifically designed for that, and then that changes your taste buds.”

The whole system, he said, is about making us want more of the things we know aren’t great for us. And it’s not a simple dichotomy between individual choice and the environment we’re living in.

Professor Swinburn describes ultra-processed foods as “heavily engineered produce. They used to be food products; now they’re edible food-like substances that we get addicted to. They’re specifically engineered to capture us in multiple ways.”

“The way that the food system has been developed, especially the ultra-processed food, is enveloping us within it. It’s nice and convenient. We like that. It’s cheap. Yep, that’s good. It has a long shelf life. Yep, We like that. It tastes really good. Yep, we like that. And so there’s lots of things that we like and desire wrapped up into this. We’re part of the environment in many ways.”

Could I have gone to the supermarket and bought some chicken and lovingly coated it in some egg and panko breadcrumbs and served it with some fresh vegetables and brown rice? yes Would it have been as tasty? Maybe, but in a very different way. Would it ultimately have worked out cheaper? Probably. Did I have the energy for the cooking and the mental gymnastics to decide what I wanted to eat? Absolutely not.

“There’s no question that takeaways are more expensive than the home cooked version. Even if you factor in people’s time at the average wage it’s still cheaper. But I suspect that people value their time higher than the average wage.”

Ultimately, it doesn’t matter what you value your time at. If you don’t have the time, the resources, the energy or ability to do it, putting food on the table for your family is a massive daily chore. This all feels very difficult to manage. For the people who are trying to figure out how to make changes at population level like Professor Swinburn, but also for people just trying to manage their own lives. I don’t know how to solve either.

What I do know is that hating the player – past me eating the delicious, delicious, nuggs – isn’t particularly helpful. it’s not a binary choice between eating the “right” thing every time or throwing myself at the mercy of a system designed to make it harder.

I make decisions all the time in my day job. I do it with as much information as I can, plus the experience I’ve gained in a decades-long career. Sometimes I get it right, and sometimes I get it wrong. I have so much more information now than I had six months ago. Hopefully that will lead to better decisions too.

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