Diabetes Is Profitable.
Why Would the System Stop It?

Type 2 diabetes makes an extraordinary amount of money. Food and beverage companies earn money selling products designed to be cheap, convenient and repeatedly consumed. Pharmaceutical, medical-device and healthcare companies earn money treating the chronic illness that can follow.

These industries do not need to cooperate. Nobody needs to sit in a secret room and decide that more people should become diabetic. Each business simply follows the incentives in front of it.

Food companies are rewarded for selling more. Healthcare businesses are paid when more care is delivered. The patient, the family, employers, insurers and taxpayers absorb most of the human and financial cost.

One industry helps pollute the pond. Another treats the frogs. The filter remains neglected because prevention is harder to turn into dependable, recurring revenue.

Nobody Has to Plan an Epidemic

Imagine two executives running competing food companies. One decides not to use every legal way of increasing sales because some strategies may worsen long-term health. The other increases portion sizes, makes the product harder to resist, advertises more aggressively and captures more shelf space.

The second company is likely to grow faster. Its executives are rewarded. Competitors copy what worked. The more restrained company loses ground.

This can happen even when nobody wants people to become ill. The sale is recorded today. The health damage may not appear for years—and when it does, it appears on somebody else’s medical record and budget.

The result is a kind of commercial evolution: products and tactics that generate the most repeat consumption tend to spread. Restraint has to compete against a system that rewards growth.

The First Industry Profits From the Food

Not all processed food is harmful. Freezing, canning and fortification can be useful. Whole grains are not the same as sugary drinks. The argument is narrower: the commercial system gives a powerful advantage to products that are cheap to make, easy to distribute, heavily marketed and effective at encouraging repeat consumption.

There is direct experimental evidence that the form of food can affect how much people eat. In a controlled National Institutes of Health study, 20 adults were offered either ultra-processed or unprocessed diets. The diets were designed to look nutritionally similar on paper. On the ultra-processed diet, participants ate about 508 extra calories a day and gained about 0.9 kilograms—roughly two pounds—in two weeks. On the unprocessed diet, they lost about the same amount.

Source: Hall et al., Cell Metabolism (2019). The study was small and short, but its controlled design makes the direction of the effect unusually informative.

Larger long-term studies cannot prove cause as neatly, but they point in the same direction. A 2023 analysis combining three large US studies with a meta-analysis found that each 10% increase in ultra-processed food intake was associated with a 12% higher risk of type 2 diabetes. Importantly, some categories were not associated with higher risk. The label is not a verdict on every packaged product.

Source: Chen et al., Diabetes Care (2023).

Then Biology Catches Up

Inside the body, the pathway is well established. It does not happen identically to everyone, and genes matter. But in susceptible people, the simplified sequence looks like this:

1. Repeated excess intake adds pressure. The body receives more energy than it can use safely.
2. Fat accumulates in harmful places. This can include the liver and pancreas, even in some people who do not look obese.
3. The body becomes less responsive to insulin. The pancreas must produce more insulin to keep blood sugar controlled.
4. The pancreas can no longer keep up. Blood sugar rises into the diabetic range.

This explains how type 2 diabetes develops. It does not fully explain why the conditions that push people down this path became cheap, normal and almost impossible to avoid.

That is the difference between a biological cause and an upstream cause. Insulin resistance is where the disease becomes visible. Corporate decisions help shape the environment that makes insulin resistance common.

The scale is enormous. The CDC estimates that 40.1 million people in the United States have diagnosed or undiagnosed diabetes, while 115.2 million adults have prediabetes.

Sources: CDC National Diabetes Statistics Report and NIDDK’s type 2 diabetes overview.

The Second Industry Profits From the Disease

Once a person develops diabetes, treatment is essential. Medicines, glucose monitors, testing, clinical care and hospital treatment can prevent complications and save lives. This article is not an argument against any of them.

But the economics are uncomfortable. Type 2 diabetes is usually a chronic condition. That creates long-lasting demand for products and services. The patient may need prescriptions, supplies, appointments and monitoring for decades.

Diabetes is profitable at both ends of the chain. Revenue can be earned from products that increase the risk and again from managing the illness that follows. The companies need not share a plan or even know one another. Their incentives merely point in compatible directions.

Prevention has a different business model. A healthier food environment, better sleep, daily movement and modest sustained weight loss may prevent years of treatment—but much of that value goes to the person and society, not to a single company that can reliably bill for it every month.

We know prevention can work. In the US Diabetes Prevention Program, an intensive lifestyle intervention reduced the incidence of diabetes by 58% relative to placebo over an average of 2.8 years among high-risk participants. Metformin reduced it by 31%.

Source: Diabetes Prevention Program Research Group, New England Journal of Medicine (2002). These are relative reductions within a high-risk study population, not reductions in everyone’s absolute lifetime risk.

But People Choose What They Eat—Don’t They?

Yes. Personal choices matter. A person can reduce risk by changing diet, activity and weight. Pretending otherwise would be both false and unhelpful.

But “people choose” is not the end of the causal story. Companies spend billions because advertising, placement, packaging, pricing, portion size, convenience and repetition change what people choose. If these techniques did not work, companies would stop paying for them.

A child does not design the supermarket, choose which products are sold beside the checkout or decide what appears in thousands of advertisements. An exhausted parent choosing between a cheap ready meal and a more expensive meal requiring preparation is making a real choice—but not under neutral conditions.

The World Health Organization calls these forces the commercial determinants of health: decisions about product design, pricing, marketing, supply chains and lobbying that shape health on a population scale.

The frogs technically choose what to buy. But the pigs control nearly every sign around the pond.

What the Evidence Proves—and What It Does Not

The evidence is strongest for the individual links. The larger conclusion—that corporate structure is itself a cause—is a synthesis. It is not the result of a randomized experiment comparing our world with an otherwise identical non-corporate world. Such an experiment cannot be done.

That uncertainty matters. But it does not make the conclusion arbitrary. Courts, accident investigators and historians routinely identify causes by joining multiple established links into the explanation that best fits the observed result.