Diabetes spike linked to reliance on staple foods

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A new study has linked Uganda’s sharp rise in Type 2 diabetes (T2D) prevalence to traditional food culture, warning that long-standing dietary habits, shaped by regional and cultural norms, may be driving the country’s growing burden of the disease.

The findings reveal that deeply rooted cultural and social norms, where people consistently consume a single type of staple food unique to their region (such as matooke for people in Buganda), may be driving unhealthy dietary habits and increasing the risk of Type 2 diabetes across various population groups.

This may be contributing to the nation’s growing diabetes burden, which shows prevalence at 3.3% (or 1.5 million) of people aged 40 and above. This is an increase from 1.4% (600,000 Ugandans) in 2014, according to statistics from the health ministry.

The study, titled Social Norms as Influencers of Type 2 Diabetes Risk-Taking Behaviours: A Qualitative Deep-Dive Diagnosis in Two High-Burden Districts in Uganda, was led by Dr Juliet Kiguli from Makerere University’s School of Public Health and published recently in the British Medical Journal (BMJ).

The study was conducted in eastern Uganda, specifically in the districts of Bugiri and Busia. Researchers collected data from health workers, caregivers, patients and community members using focus group discussions, in-depth interviews and non-participant observation.

According to the report, the areas of study were chosen due to the high prevalence of Type 2 diabetes in the area. For example, the study found a diabetes prevalence rate of 7.4% among people aged over 35 in these districts, compared to the national average of 3.3%.

“These regional differences highlight the complex interplay of cultural, social, and environmental factors influencing diabetes risk across the country,” said the report.

Uganda spends approximately sh2.2 trillion annually on treating diabetes, according to the health ministry.

What is Type 2 diabetes?

Type 2 diabetes is a chronic condition where the body either does not produce enough insulin or the insulin it produces does not work properly (insulin resistance), leading to high blood sugar levels. This means the body has difficulty regulating blood glucose, which can lead to various health complications if left unmanaged.

“In districts like Busia, the study found that the daily consumption of millet (locally known as Bwita/kalo) combined with meat or fish often discourages the inclusion of healthier, more diverse food items crucial for overall health protection against non-communicable diseases like diabetes,” said the report.

“Type 2 diabetes (T2D) sits at the intersection of culture and nutrition, highlighting the need to examine how cultural influences shape food systems, particularly the impact of ‘staple food syndrome’ on health outcomes in culturally sensitive communities.”

It noted that cultural institutions can play a crucial role in addressing T2D-related risk behaviours, as people often conform to food norms, either out of fear of social sanctions or in pursuit of social acceptance.

Health experts weigh in

Andrew Ssekitoleko, a clinical nutritionist at Mulago Hospital, says overindulgence in one type of food, particularly carbohydrates, is a common risk factor for diabetes and has been associated with an increase in cases of obesity.

“Obesity is the accumulation of fat in the body. When that happens, the body loses its shape and size. If someone is obese, they are at a high risk of developing diabetes,” he said, adding that obesity is often accompanied by other complications, such as high blood pressure, kidney failure and related illnesses.

He advised Ugandans to avoid eating only one type of food, which could lead to over-nutrition and imbalance in the body.

“If it is carbohydrates and all you eat is cassava, then that is all your body gets,” Ssekitoleko said.

He noted that different people react differently to different foods and monitoring blood sugar is critical.

“We recommend that patients measure their blood sugar before eating. That way, they can better manage their intake and avoid complications,” Ssekitoleko said.

Eat in moderation

Dr Charles Olaro, the Director General of Health Services at the health ministry, said, “Anything with carbohydrates, even bread, should be eaten in moderation.”

Dr Olaro acknowledged that diabetes is becoming a major public health concern and said the Government is prioritising prevention by investing in public sensitisation to stop the disease from spiralling out of control.

He noted that factors such as genetics, metabolism and alcohol use also contribute to the risk.

“Our people need to be aware of the full range of risk factors. The good news is that you can prevent diabetes through simple changes like reducing carbohydrate intake, increasing fruit and protein consumption, exercising, and going for regular health checks,” Dr Olaro said.

Dr Olaro also pointed out that, besides the well-known Type 1 (childhood onset) and Type 2 (adult onset) diabetes, there is an emerging form of the disease linked to chronic malnutrition.

He urged Ugandans to take the disease seriously, noting its effects are far-reaching and impact the entire body from head to toe.

“Diabetes can lead to vision problems. It affects the kidneys, increases blood pressure and can lead to kidney failure. It blocks blood vessels, causing gangrene. In men, it may result in erectile dysfunction due to damage to small blood vessels. So yes, it affects every part of your body,” Dr Olaro said.

Community influencers’ role

The study said the negative norms are being propagated because there are several key reference groups in society influencing T2D diet-related risks.

It named some of these as female parents or wives, co-wives, children, husbands and traditional herbalists.

“Male parents, in particular, often wield significant power in determining food choices and preparation,” said the report. “Wives, despite knowing better, are often vulnerable to sanctions ranging from violence to divorce if they do not conform to their husbands’ preferences for unhealthy, weight-gaining foods. Community respect for fat people, especially men, also pressures wives to prepare rich foods, reinforcing unhealthy habits.”

“This highlights the critical need for interventions to adopt a multi-stakeholder, collaborative, family and community-centred approach involving non-conventional health stakeholders, such as cultural leaders and community influencers, to effectively address these deeply entrenched behaviours and promote positive health outcomes.”

The researchers noted that the findings underscore that combating the rise of Type 2 diabetes in Uganda requires more than just medical interventions. It necessitates a comprehensive societal shift, challenging long-standing cultural beliefs and gender dynamics that inadvertently undermine public health.

Every region in Uganda has a staple food that defines its identity. For example, Juma Mukiibi, a taxi driver, says he does not feel satisfied unless his meal includes matooke — cooked, mashed and steamed.

“I struggle a lot when I travel to areas where matooke is not on the menu,” he said.