Today, just under 30 million people have diabetes. That’s 9.3 percent of the U.S. population. While some of those cases are type 1 diabetes, meaning the person’s body doesn’t produce the hormone insulin, most cases are type 2 diabetes. The people in this group produce insulin, but not in great enough quantities to handle the sugar that’s in their blood. Without regular insulin injections, diabetics face serious and sometimes fatal risks.

Unlike type 1 diabetes, which is congenital, type 2 diabetes tends to emerge through other factors. It’s spurred on by things like poor diet and a lack of exercise — the hallmarks of obesity. In the U.S., more so than in other countries, people run into no shortage of opportunities to indulge. Suburban sprawl and fast food have made regular physical activity and healthy eating two active choices people must make on a daily basis, rather fixtures in a fitness-focused routine.

Some of the epidemic comes from will power, but research is finding most of the blame lies with external factors. Low-income families are more obese because healthier food is expensive. Americans work longer hours than most other countries and get too little sleep, which can leave them with neither the time nor the energy to cook. Even if people did have the time, finding healthy food on the cheap has been a struggle. Government programs were recently found ineffective in promoting healthier food choices in grocery stores.

These conflicts translate into unhealthier citizens and a burdened health care system. Diabetes makes that effect clear: The total estimated cost of diabetes, direct and indirect, is $245 billion.