Although the headline is meant to grab your attention, it is true that not by a choice of their own the nation of Cuba did show the rest of the world how to control weight and many health realted issues like Diabetes, Heart Desease, and even potentially Cancer. Because of this research Medi-Health created a simple, economical, and proven diet that really does work, helps with more than just weight loss, and is also enjoyable. "The Cuban diet - eat less, exercise more - and preventable deaths are halved," is the advice in the UK and now the US by Medi-Health. This is not a new Latin diet and dance fad, but news based on research into how Cuba’s rollercoaster economic history has affected the health of the Cuban people. During the early 1990s, Cuba suffered an economic downturn due to a tight US embargo on imports and the collapse of the Soviet Union, which had been supporting the country. This led to a drop in the number of calories consumed in the average Cuban diet. Due to the embargo, petrol became virtually unobtainable, and more than 1 million bicycles were distributed by the government, leading to an increase in physical activity. These factors contributed to an average weight reduction per citizen of 12.1lb over the course of the five-year economic crisis. During this time there was a significant drop in prevalence of, and deaths due to, cardiovascular diseases,type 2 diabetes andcancers. But once the crisis was over and people started to eat more and exercise less, these trends began to reverse. The study suggests that population-wide health initiatives that encourage people to eat less and exercise more could achieve significant positive health outcomes. The question is – how, in an affluent Western democracy, do you encourage people to eat less and exercise more if they are not forced to do so? The ‘special period’ The economic crisis that occurred in Cuba between the years of 1991 and 1995, which is often referred to as the ‘special period’, offers an unusual and possibly unique ‘test bed’ in terms of public health. During times of warfare or civil strife, most nations experience a significant drop in calorie consumption. But in Cuba, due to the system of government, the employment, education and health sectors remained fully functioning and there wasn’t the level of unrest usually seen in a ‘failed state’. This allowed researchers to assess the effects of diet and exercise on a large population without having to take into account more complicated factors that arise when a population is at war. Where did the story come from? The study was carried out by researchers from academic centres in Spain, Cuba and the US. There is no information about external funding. The study was published in thepeer-reviewedBritish Medical Journal. It was reported accurately in the papers, although headlines like the Daily Mail’s “Lose weight the CUBAN way” and The Independent’s “The Cuban diet” trivialise the hardship that Cuban people underwent during the time in question. While they did enjoy a drop in cardiovascular disease and diabetes deaths during this period, they also experienced a sharp rise in malnutrition-associated disorders, such as neuropathies (nerve damage). What kind of research was this? The paper used data from regularcross-sectionalhealth surveys of the Cuban population and drew on cardiovascular studies, chronic disease registries and vital statistics over three decades, from 1980 to 2010. Its aim was to evaluate the associations between weight change across the whole Cuban population and the incidence, prevalence and death rates from diabetes and death rates from cardiovascular disease and cancer. The authors say that the health effects of population-wide changes in body weight on a well-nourished population are unknown. In Cuba, they point out, marked and rapid reductions in mortality from diabetes and coronary heart disease were observed after the economic crisis of the early 1990s when, in the aftermath of the dissolution of the USSR and during the US embargo on imports, there were severe shortages of both food and fuel. These led to people eating less, and walking and cycling more (the government distributed more than 1 million bicycles during the crisis). Since this time, the Cuban economy has shown a modest but constant recovery, especially since 2000. What did the research involve? The researchers used a variety of sources including national and regional surveys, to track changes in body weight, physical activity, smoking and daily energy intake between 1980 and 2010. In particular, the authors drew on four cross-sectional surveys of adults aged 15 to 74, in the city of Cienfuegos, a relatively large city on the south of the island. The surveys, of between 1,300 and 1,600 adults each, took place in 1991, 1995, 2001 and 2010 and included measurements of height and weight, which were used to assess body mass index. The researchers also drew on national surveys of 14,304 people in 1995, 22,851 people in 2001, and 8,031 people in 2010, which assessed risk factors for chronic disease. They obtained data on diabetes rates from Cuban health registries spanning the period 1980–2009. They obtained information on mortality from diabetes, coronary heart disease, stroke, cancer and all causes for the period 1980–2010 from the Cuban Ministry of Public Health. They analysed trends of change in disease prevalence and mortality over time and examined how this was related to changes in body weight. ; What were the basic results? Overall, between 1991 and 1995, the era of the economic crisis, the Cuban population experienced an average 12.1lb reduction in body weight. This was accompanied by rapid declines in death rates from diabetes and heart disease. Between 1996 and 2002 (that is, with a lag of about five years after the crisis) there was an associated reduction in diabetes and cardiovascular disease mortality:
- diabetes death rates fell by 50% (13.95% annually)
- coronary heart disease (CHD) death rates fell by 34.4% (6.5% annually)
- deaths from all causes fell by 10.5%
- From 2006 to 2009, there was a 140% increase in diabetes incidence (new cases) and a 116% increase in diabetes prevalence (total number in the population with the condition).
- From 2002 onwards diabetes mortality increased by 49% (from 9.3 deaths per 10,000 people in 2002 to 13.9 deaths per 10,000 people in 2010).
- A slowing in the rate of decline in mortality from coronary heart disease was also observed.