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intro		This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practitioner with the symptoms of diabetes (see appendix 1). Jack has several demographic and lifestyle factors which will affect his disease experience, some of which are changeable and some which are not. A discussion of the types of diabetes will be followed by an investigation into some of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will be to explore how the risk factor of obesity can impact upon the development of this disease and how the reduction of weight can significantly improve the health and lifestyle of of an individual who finds themselves in this situation from a public health perspective. Research will involve the types of health promotional services available at both a micro and macro level. This will be followed by an evaluation of these
Needs Assess	diabetes	The World Health Organisation defines Diabetes as "... a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces" (World Health Organisation on-line 2008a). It goes on to suggest that it accounts for 5% of global deaths annually and that 80% of diabetic are inhabitants of low or moderate income countries. The Organisation elsewhere differentiates between type one diabetes, where insufficient insulin to support life is excrete, type two, where inappropriate somatic responses to insulin production and Impaired Glucose Tolerance and impaired fasting glycaemia where blood glucose is raised but to below that which would be indicate a diabetic diagnosis.
		The symptoms with which Jack could be presenting numerous. These could include the passing of large volumes of undiluted urine (polyuria) and an excessive thirst (polydipsia) (Marib and Hoehn, 2007). Both these symptoms are caused by hyperglycaemia in that the excessive glucose in the blood has an osmotic effect on the kidney tubule inhibiting them reabsorbing water that thus causes vast quantities of urine which then results in reduced circulating volume causing dehydration which activates the hypothalamic thirst centres causing polydipsia. As the large amounts of glucose can not enter cells as insulin is not facilitating this, the lack of energy causes hunger (polyphagia). The NHS Direct Website (2008) mentions also that tiredness, and less commonly genital itching, frequent Thrush infections and blurred vision
		Body Mass index (BMI), the calculation of weight divided by height squared, has been widely used as an indicator of obesity, normal weight and under weight. It is one of the factors that is included in several nutritional scores. It can provide a basic analogue of whether any weight management activities need to be implicated. However, it is limited in that it does not take into account any risk factors. Moreover, there is now much research which brings into question the validity of BMI. Waist measurement is now being mooted as a more reliable predictor of risk with regard to weight.
		The Diabetes Prevention Research Group (2002) and the Finnish Diabetes Prevention Study (Lindström et al, 2003) carried out randomised controlled trials which have indicated that diabetes can be delayed or even prevented with moderate increases in physical activity and improvements in diet. The former showed that found that weight loss of between 5% and 7% of total body weight accompanied with moderate physical activity of half an hour five times per week proved to be almost doubly effective as the use of the glucose lowering medication namely Metformin. The latter compared an intervention group against an interventions group but only of 40 to 64 year olds where as the former investigated subject of 25 years and older. More research may bring forth some more answers, especially if it were longitudinal in nature.
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		DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) is a national education program tailored for individuals with Diabetes type 2. Being primarily piloted by 15 English Primary Care Trusts (PCTs) from 2004 and is now being tested via a 1000 subject randomised control trial in selected English and Scottish PCTs. Taking its lead from the National Institute for Health and Clinical Excellence guidance on diabetes, DESMOND is a form of secondary health promotion in that the individuals have already been diagnosed so the emphasis is on preventing the Prior to 2003 when the diabetes National service framework and the National Institute for health and clinical excellence published their guidance on diabetes, there was no benchmark by which education schemes could be validated. Desmond Caulfield's all By its very design, Desmond has been tailored to meet the standards laid in out in these policies. Beginning with a programme primarily for individuals who had just been diagnosed with diabetes, Desmond progressed Has progressed to developing pathways of care for individuals for the whole of their disease journey. DESMOND's education groups are based on Leventhal's common sense theory,where the dual process theory, and the social learning theory which on of the advantages of DESMOND is that it is very client focused, tailoring its imput to the individual concerned. At the very heart of the orgnaisation are both healthcare professionals as well as individuals with diabetes thus integrating scientific knowledge base with clincial experience and the lived experience of those with the disease. Conversely, Desmond is an example of secondary prevention in that the aim of the intervention is a the emphasis is on the However, Desmond is an example Both secondary and cursory attention encompassed within the Desmond ideology in that The secondary prevention The secondary preventive ethos is that of aiming to prevent the progression of diabetic process Prevention of the progression of the disease process or of her unwonted state through early detection when this favourably affects outcome The cursory element The cursory prevent the development of his concerns with the prevention of avoidable complications of panic irreversible, manifest disease or prevention of the the occurrence of an illness or other unwonted phenomenon Downey, beginning with a programme before diabetes Beginning with a programme primarily for individuals who had just been diagnosed with diabetes, Desmond progressed Has progressed to developing pathways of care for individuals for the whole of their disease journey. Although this
		Jack is reported to be obese. The definition of this varies and tend to be This has several ramifications. This not only places him at higher risk of Diabetes type 2 but also cardiovascular complication such as coronary heart disease and myocardial infarction but also joint problems such as osteoarthitis. Després et al (2001) suggest that individual's abdominal weight be measured and recorded on admission and be considered as a vital sign. the Joint Health Surveys Unit (2003) found that 21% of Male and 23.5% of females were obese.
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