CHAMPAIGN – Dr. John Stokes reaches into a pile of magazines in a Christie Clinic exam room and grabs one with a luscious-looking dessert on the cover.

So much of our society centers around eating, he says. Is it any wonder his patients have such a tough time controlling their weight, even when their lives depend on it?

"Everywhere you go, you're bombarded by food," he says.

A Christie Clinic endocrinologist, Stokes treats some of the growing number of people with diabetes, a disease growing at epidemic proportions despite public health efforts to encourage people to lose excess weight and exercise more – both moves that can prevent the onset of type 2 diabetes, the most common form of the disease.

Globally, more than 250 million children and adults have diabetes, and health experts expect to see that total grow to 380 million within 20 years, according to the International Diabetes Foundation. Much of that growth is projected to be in type 2 diabetes among children and adolescents who are overweight, inactive and eating high-fat, low-fiber, heavily processed food.

Stokes says so many people succumb to diabetes and its complications because avoiding and controlling it takes so much hard work on the part of patients.

"If I tell you, 'You have to change the way you eat and exercise your butt off five days a week,' it's hard," he says.

Even when people know they're on the edge of diabetes, they often have a tough time making lifestyle changes to avoid it, according to Stokes.

People rationalize the symptoms as signs of aging. They tell themselves they won't be one of the unlucky ones who get diabetes, or they won't be one of the diabetics who develop complications.

Society doesn't help any, Stokes says: The average portion sizes these days are twice what they were in the 1960s, and the average lifestyle involves far too much time sitting.

Rather than fostering changes that makes patients feel deprived, Stokes tells those with pre-diabetes and those in the early stages of the disease that they have a big opportunity to take charge of their health, he says.

"I never tell people they can't have anything," he adds. "I try to make them aware of the consequences of their decisions."

The consequences of bad decisions for those with diabetes can be cardiovascular, nerve, eye and kidney disease.

Two-thirds of people with diabetes will die of a cardiovascular event, Stokes said, but patients can help themselves avoid complications by meeting their goals for weight loss, blood sugar and cholesterol levels.

While there isn't a cure for diabetes, the treatments available these days are much better than the ones available 20 years ago, Stokes said – though some good medications remain frustratingly out of reach because insurers won't cover them.

Stokes says he can't go through the lunch line with his patients or work any magic to make lifestyle changes easier. But he does tell patients that if they make good choices, there are few things in life they won't be able to do with diabetes.

"It's as limiting as you want it to be," he says.

Small changes

Christie Clinic dietitian Jennifer Vissers, who teaches diabetic patients how to make those lifestyle changes, says many people are surprised to find out what foods they can still eat.

Another surprise: You don't have to make big changes to prevent or delay diabetes: A 5 to 10 percent weight loss and 30 minutes a day of exercise four or five days a week will make a big difference, Vissers said.

Increasing activity doesn't require running a marathon, either. It can include the small stuff, such as taking the stairs instead of the elevator and parking your car farther away from your destination, Vissers says.

"Every little bit helps," she adds.

Are you at risk for diabetes?

To help identify more people at risk for diabetes, Christie Clinic has scheduled a diabetes expo open to everyone for World Diabetes Day on Friday at the Windsor Road branch clinic.

From 9 a.m. to 3 p.m. that day, there will be free blood-sugar and diabetes-risk screenings offered, plus patient-education materials and chances to sign up for classes and support groups offered through the clinic.

Consider being screened if you have a family history of diabetes, are obese (with a body mass index of 30 or higher) or are experiencing such warning signs as blurred vision, thirstiness, fatigue or frequent urination, Stokes advises.

Screening those at risk is important because there are many people already in the early stages of diabetes who aren't being treated because they don't know they have it.

In the United States alone, 23.6 million people have diabetes, and 25 percent of the cases are undiagnosed, according to the American Diabetes Association.

Facts to know about diabetes

What is diabetes?

A chronic condition that develops when the pancreas either doesn't produce enough insulin (a hormone that helps convert food to energy) or can't effectively use the insulin it produces.

Two main types

— Type 1, an unpreventable disease resulting from failure to produce insulin and requiring insulin injections; most common in children and young adults.

— Type 2, a potentially preventable disease resulting from insulin resistance in the body; it affects both children and adults.

Total cases worldwide

250 million, projected to grow to 380 million within 20 years.

Total cases in U.S.

23.6 million, or 8 percent of the population. One in four people with diabetes doesn't know he or she has it.

Potential complications of diabetes

Cardiovascular, kidney, eye and nerve diseases. Children with diabetes run a high risk of developing these complications at a young age.

Economic effect in U.S.

$174 billion in 2007.

Sources: International Diabetes Foundation and American Diabetes Association