Eight weeks ago Craig Kawiti couldn't walk to his mailbox.
Overweight with a weak heart and diabetes, the kind and bubbly Tauranga man was unrecognisable thanks to a beard he'd grown to hide from his friends.
He was ashamed of what he had become and lost all confidence in himself.
But yesterday, he climbed Mauao for the tenth time.
With each step, Kawiti is reclaiming his confidence. He is 20kg lighter, can bend down and tie his laces and his type 2 diabetes levels are dropping - slowly but surely.
About 8000 people in the Western Bay of Plenty region have type 2 diabetes, including 1400 Māori and 200 Pasifika. About 4500 are men.
The number of Kiwis with type 2 diabetes is projected to rise by 70 to 90 per cent by 2040 if nothing is done, according to a recent PwC report.
Commissioned by Diabetes New Zealand, the University of Otago's Edgar Diabetes and Obesity Research Centre and Healthier Lives National Science Challenge, the report estimated the $2.1 billion spent treating those with diabetes would increase by 63 per cent to $3.5b in 20 years due to the rise in type 2 diabetes.
People would develop the disease younger and there would be worse health outcomes for minorities if "no action is taken now", the report found.
However, there were four interventions that could save hundreds of millions of dollars, increase life expectancy and improve quality of life for a huge number of New Zealanders.
For Kawiti, diet and exercise have changed his life after health problems at the start of last year saw him lying in a hospital bed "packing on the weight".
Type 1 diabetes is an auto-immune disease while type 2 will develop most commonly in people's late 30s, but both result in the body not creating enough insulin to keep blood glucose (sugar) levels in check.
For Kawaiti, needing insulin injections was his turning point towards change.
"I knew I wasn't going to last long if I didn't, I just felt it.
"I couldn't walk to the letterbox and I was getting worse every day."
Kawiti joined Sport Bay of Plenty's green prescription programme, designed to use community connections to nurture healthy lifestyles.
He started walking - in the dark at first, to avoid judgement - and has since walked right around the Bay of Plenty.
"After the first week I started doing things but my body size was still the same - I was able to bend down ... I didn't have a neck cause I was quite big, but now I can look around everywhere.
"I can run now ... before I was scared of falling over all the time cause I had balance problems."
Now he's looking forward to reaching the six month mark where he will shave off the beard he hides behind.
Western Bay of Plenty Primary Health Organisation (PHO) clinical advisor Dr Fiona Whitworth said the number of people with type 2 diabetes in the region is expected to grow over the next 20 years, in line with projected increases nationwide.
"We will definitely see more type 2 diabetes in our communities unless we see significant change occur in lifestyle choices, including diet, weight management and activity levels.
"We need to increase health literacy and awareness of diabetes and pre-diabetes. That means reinforcing the messages of healthy eating and increased activity which are proven to reduce the risk of developing type 2 diabetes."
The PHO funds 33 general practices in the Western Bay of Plenty and Whakatāne and provides complementary health services in the community, some of which target people at risk of developing diabetes.
As a preventative measure, the PHO is funding local medical centres to offer increased support to Māori, Pasifika and Asian people, as well as Community Service Card holders identified as being at risk of developing diabetes.
Diabetes New Zealand Bay of Plenty district manager Karen Reed said health services were struggling to provide adequate care and support for people with diabetes.
A doubling of diagnosis rates in two decades was alarming, Reed said.
"These projections suggest we are failing our communities when it comes to health messaging."
As numbers continued to rise, greater investment would help to counter the "devastating effect" the disease would have on communities, she said.
"The report looked at four potential interventions in detail – I'd like to see support to help us put these and more into action – we need more funding, more resources and we need to be creative in using these resources, we need to work collaboratively and we need a New Zealand-wide approach."
Reed worked on the recently published report and said it wasn't about helping people to live healthier lifestyles but taking steps to break down the barriers.
"The food industry has a large part to play in this, schools and workplaces, we need to address social and economic barriers.
"It's not just what we eat or how much we exercise, it's much bigger than that — it's about how we live."
Fifth Ave Family Practice GP Dr Luke Bradford said the projected rise of type 2 diabetes aligned with his experience.
Regular testing and measuring for diabetes was an area the health system wanted to focus on as it was a disease health professionals could often see coming, he said.
However, Bradford also questioned how the industry encouraged people to live healthier lifestyles.
"How do we get people up and moving? How do we get them to eat healthier and be aware that weight is an issue?
"But how do we bring Māori and Pasifika and our south Indian neighbours along with us on this journey and let them lead in a way that makes sense for them?
"How do we protect their tikanga, but at the same time, protect them from his illness?"
Otago University Edgar Diabetes and Obesity Research Centre director, Professor Rachael Taylor, said something needed to change to stem the growing "epidemic".
"Type 2 diabetes is not tracked as a national health target for a start, and yet the figures are growing at an alarming rate.
"All eyes remain on Covid-19 as a major current global health issue, but New Zealand is facing a staggering increase in numbers of people with type 2 diabetes and astronomical costs associated with this disease."
Healthier Lives National Science Challenge director Professor Jim Mann said the industry had known type 2 diabetes was a worrying issue for a long time.
"But we now know that its impact on New Zealand can be measured as a fraction of GDP with the $2.1b annual equivalent to 0.67 per cent of GDP.
"That's just for this one disease and is in purely financial terms, let alone the human cost to individuals and their whānau."