Mark Hyman
Not having enough food to eat may cause obesity, diabetes, high blood pressure, and heart disease. Most of us think the chronic disease epidemic is fueled by abundance, but it may be fueled as much by food scarcity and insecurity as it is by excess. And, right now, America is suffering from the highest levels of poverty and food insecurity that it has seen in more than a decade.
In 2008 49 million Americans--including 16.7 million children--lived in a home at risk of not having enough food on the table every day. After working in Haiti, the poorest country in the Western hemisphere, I learned that one in two Haitians wake up every day not knowing where their next meal will come from. But right here in the wealthiest nation in the world, one in five children live in poverty, one in four children live on food stamps, and one in 10 people don't know where their next meal will come from.
A new report released by Bread for the World shows that not all families in the United States are feeling the burden of food scarcity equally. Analyzing the country's most recent poverty and hunger statistics, the report found that one in four African-American households struggles to put food on the table on a regular basis, compared with about one in seven households nationally.
This news comes on the heels of recent estimates by researchers at Washington University in St. Louis that suggest 90 percent of African American children will receive food stamp benefits by the time they turn 20 - a claim this report found to be true.
It seems clear that the drastic disparity in unemployment rates between African Americans and the general population is fueling high rates of hunger. Bread for World's report cites unemployment numbers from January 2010 that show 16.8 percent of African Americans were unemployed last month while only 9.7 percent of the general population was out of work.
Naming the current economic crisis as a driving factor behind these figures, Bishop Don Williams of Bread for the World goes as far as to say that "an entire generation of African American children is at risk of being set back due to the current recession."
The Census Bureau recently reported that the nation's poverty rate increased to 14.3 percent in 2009--the highest level we've seen since 1994. 43.6 million Americans lived below the poverty line in 2009, earning less than $21,954 per year for a family of four or $10,956 for an individual; for African-Americans 1 in 4 are poor (25%) and nearly 40% of Black children live in poverty. We now have the highest number of people living on the threshold of poverty in the history of government record keeping.
The poorest areas of the country are also the sickest and have the highest rates of obesity, diabetes, and premature death. These people are dying younger, and life expectancy is plummeting in the poorest states. These states also happen to be the fattest. For example, Mississippi the poorest state in the union has poverty rates over 20 percent, obesity rates over 33 percent, and extremely high childhood obesity rates. This is no coincidence.
How does not having enough to eat cause obesity, diabetes, heart disease, cancer, and early death? Let's investigate.
Food Insecurity: The Root of Obesity and Disease
The Life Sciences Research Office says food insecurity exists "whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways (e.g., without resorting to emergency food supplies, scavenging, stealing, or other coping strategies) is limited or uncertain." This may mean going hungry for some. But for a large portion of Americans floating on or sinking beneath the poverty line this means bingeing on cheap, sugary, starchy, fatty calories in order to avoid hunger.
Many poor people in this country are consuming an excess of nutritionally-depleted, cheap calories from sodas, processed foods, and junk food. These folks scarcely eat whole, fresh foods at all, and for good reason: We have made calories cheap, but real food expensive.
Almost $300 billion of government subsidies support an agriculture industry that focuses on quantity not quality, on producing cheap sugar and fats from corn and soy that fuel both hunger and obesity.
These calorie-rich, sugary, processed foods are what most people buy if they don't have enough money. You can fill up on 1200 calories of cookies or potato chips for $1, but you'll only get 250 calories from carrots for that same $1. If you were hungry, what would you buy?
Processed foods have become cheaper as real food grows more expensive. The U.S. Department of Agriculture (USDA) reported that between 1985 and 2000 the retail price of carbonated soft drinks rose by 20 percent, fats and oils by 35 percent, and sugars and sweets by 46 percent.
Compare that to the 118 percent increase in the retail price of fresh fruits and vegetables. In fifteen years the price of vegetables ballooned six times as fast as the cost of sugary, calorie-rich, nutrient-poor sodas.
This is further compounded by the fact that in some communities in America, the only place to buy food is a local convenience store where fruits, vegetables, or other whole, fresh, real foods cannot be found. Without a car in an urban setting you may have to walk miles to find anything resembling real food.
Social factors like these set the stage for the epidemics of obesity and disease we are facing. This in combination with the nature of human metabolism put our nation's poor in a trap from which it is very difficult to escape.
How the Biology of Starvation Contributes to Disease
What often happens in poverty-stricken families is a hunger-bingeing cycle that follows the economic conditions in the household. When resources come in, people buy cheap, abundant calories in the form of junk and processed foods that fill them up and stave off hunger leading to rapid fat storage, a common biological effect after a period of lower calorie intake or hunger. This is simply how human metabolism works.
When calories are scarce metabolism slows down and muscle is lost. As a result the blood sugar imbalances that drive the process of insulin resistance and lead to pre-diabetes and diabetes worsens, and soon people are caught in a recurrent pattern of bingeing on nutrient-poor calories once resources are again available.
Certainly people can learn to eat better for less as I pointed out in my recent blog on the topic, and doing so is an essential part of what needs to happen to break out of this cycle of poverty and disease as I will discuss more below. That said, breaking the hunger-binge cycle is easier said than done.
Bingeing after food scarcity and the increased fat accumulation and insulin resistance that come along with it are hard-wired biological mechanisms to prevent us from starvation. Once you have diabetes, engaging in this cycle makes blood sugar control that much more difficult and leads to the swings of high and low sugar that drive health problems and their related costs.
Diabetics without access to adequate food have fives times as many doctor visits as diabetics who have enough to eat on a regular basis. The burden this creates in families already struggling to stay afloat is unspeakable. It's like they are caught in a Grecian hell--pushing the boulder of economic burden up a hill they will never see the top of, reaching for fruit that grows ever further from their reach.
We need to rethink how and what we feed our nation or the epidemics of disease and obesity will consume us. In Haiti, one in two people worry about where their next meal will come from. In America it is one in 10. In order to shift this we need a bold new vision and initiatives that can change our food culture and food availability.
Here are a few initiatives and ideas that may help shift this frightening tide of poverty and disease:
1. Stop or reduce subsidies of agriculture products that allow for the glut of cheap, high-calorie, nutrient-poor sugars and fats from corn and soy into the marketplace.
2. Consider taxing sugar and processed food to support national food programs and community projects, and help cover the hundreds of billions of dollars of health care costs from increasing obesity, diabetes, and heart disease.
3. Fund community-based initiatives to support healthy eating including community kitchens, gardens, and cooking classes that teach how to make good food cheaply. This is part of the new health care bill, and on the agenda of the new Council on Prevention, Health Promotion, and Public Health.
4. Make school lunches healthy by providing only real food and modeling healthy eating. Food can be both fun for you and good for you. Create national standards based on sound 21st century nutritional science and common sense. Most schools have only a microwave or deep fryer, hardly the tools needed to feed our children real, fresh food.
5. Expand the Supplemental Nutrition Assistance Program (formerly the Food Stamp Program). Increasing eligibility, helping those who are not aware they are eligible enroll, and creating new programs that support consumption of more healthful foods could shift the tide of the widening socioeconomic disparities in chronic disease.
You should not be able to buy chips and soda with food stamps.Everyone reading could also sign up for Jamie Oliver's Food Revolution and learn a recipe using inexpensive, fresh, whole food to create a delicious meal and teach that recipe to three people. They, in turn, could teach three more people. After just a few rounds of that, all of America would learn how to feed themselves again.
We need to reclaim our food supply and revive traditional ways of eating. As Michael Pollan says, "If 'food' was made in a plant, don't eat it. If it grows on a plant, then enjoy!"
Sunday, September 19, 2010
Tuesday, September 14, 2010
Stress And Black Obesity
The main cause of obesity is overeating. However, not many people know the causes of overeating; one major cause is ‘socioeconomic stress’. Blacks are the most stressed population in the U.S. Just living under the stressor of racism alone takes a tremendous psychological toll on so many Black people.
In her book, ‘Environmental Stress and African-Americans’, author Grace Carroll states that race is brought to the consciousness of African Americans every day through interaction with employers, service providers, landlords, the police, and the media.
She says the stress experienced by Blacks merely as a result of being African American causes micro-aggressions that include experiences such as being denied service, being falsely accused, being negatively singled out on account of one's race.
Carroll labels the stress that results from such micro-aggressions as Mundane Extreme Environmental Stress (MEES) - which she says is a daily experience, has a significant impact on one's psychological well being and world view, is environmentally induced, and is detracting and energy consuming.
Arline Geronimus a professor of health behavior and health education at the University of Michigan echoes Carroll by stating the stress of living and working in a race conscious society slowly wears down Black people from all walks of life.
From Geronimus perspective racist stress, coupled with poverty, eventually erodes Blacks mental and physical health, a gradual process that she calls ‘weathering’. This daily weathering results in depression, substance abuse, suicide, strained relationships, and frustration that leads to misplaced Black-on-Black violence.
Living under much strain Blacks tend to eat comfort foods high in fats and sugars to ease the pain of stress. Black obesity is driven by stressful emotion based reactive eating and an addiction to comfort foods. Stress can make you feel hungry even though you just ate. Because of this reason Blacks tend to eat more portions and obesity continues to rise.
In her book, ‘Environmental Stress and African-Americans’, author Grace Carroll states that race is brought to the consciousness of African Americans every day through interaction with employers, service providers, landlords, the police, and the media.
She says the stress experienced by Blacks merely as a result of being African American causes micro-aggressions that include experiences such as being denied service, being falsely accused, being negatively singled out on account of one's race.
Carroll labels the stress that results from such micro-aggressions as Mundane Extreme Environmental Stress (MEES) - which she says is a daily experience, has a significant impact on one's psychological well being and world view, is environmentally induced, and is detracting and energy consuming.
Arline Geronimus a professor of health behavior and health education at the University of Michigan echoes Carroll by stating the stress of living and working in a race conscious society slowly wears down Black people from all walks of life.
From Geronimus perspective racist stress, coupled with poverty, eventually erodes Blacks mental and physical health, a gradual process that she calls ‘weathering’. This daily weathering results in depression, substance abuse, suicide, strained relationships, and frustration that leads to misplaced Black-on-Black violence.
Living under much strain Blacks tend to eat comfort foods high in fats and sugars to ease the pain of stress. Black obesity is driven by stressful emotion based reactive eating and an addiction to comfort foods. Stress can make you feel hungry even though you just ate. Because of this reason Blacks tend to eat more portions and obesity continues to rise.
More Than 1 in 3 Blacks Are Obese
by Robert Higgs
Nearly 36 percent of black Americans are obese -- much more than other major racial or ethnic groups -- and that gap exists in most states, a new federal study finds. About 29 percent of Hispanics and 24 percent of whites are obese, the Centers for Disease Control and Prevention reported.
Racial differences in obesity rates have been reported before, and health officials were not surprised to see larger proportions of blacks tipping the scales. But the new CDC report is the first to look at the gap on a state-by-state level, finding blacks had much higher obesity rates in 17 states, and had rates about as high or higher than other groups in an additional two dozen more states.
Health officials believe there are several reasons for the differences. People with lower incomes often have less access to medical care, exercise facilities and more expensive, healthier food. In many places, minorities are disproportionately poor.
But attitudes about weight also are believed to be a factor, said Dr. Liping Pan, a CDC epidemiologist. "Black and Hispanics are more accepting of high weight," she said, adding that heavy people who are satisfied with their size are not likely to diet or exercise.
Obesity is based on the body mass index, a calculation using height and weight. A 5-foot, 9-inch (1.75-meter) adult who weighs 203 pounds (92 kilograms) would have a BMI of 30, which is considered the threshold for obesity.
The data comes from national telephone surveys of hundreds of thousands of Americans in the years 2006 through 2008
Nearly 36 percent of black Americans are obese -- much more than other major racial or ethnic groups -- and that gap exists in most states, a new federal study finds. About 29 percent of Hispanics and 24 percent of whites are obese, the Centers for Disease Control and Prevention reported.
Racial differences in obesity rates have been reported before, and health officials were not surprised to see larger proportions of blacks tipping the scales. But the new CDC report is the first to look at the gap on a state-by-state level, finding blacks had much higher obesity rates in 17 states, and had rates about as high or higher than other groups in an additional two dozen more states.
Health officials believe there are several reasons for the differences. People with lower incomes often have less access to medical care, exercise facilities and more expensive, healthier food. In many places, minorities are disproportionately poor.
But attitudes about weight also are believed to be a factor, said Dr. Liping Pan, a CDC epidemiologist. "Black and Hispanics are more accepting of high weight," she said, adding that heavy people who are satisfied with their size are not likely to diet or exercise.
Obesity is based on the body mass index, a calculation using height and weight. A 5-foot, 9-inch (1.75-meter) adult who weighs 203 pounds (92 kilograms) would have a BMI of 30, which is considered the threshold for obesity.
The data comes from national telephone surveys of hundreds of thousands of Americans in the years 2006 through 2008
Black Americans Less Likely to Recognize Obesity
by Gary G. Bennett, PhD
Overweight black Americans are two to three times more likely than heavy white Americans to say they are of average weight — even after being diagnosed as overweight or obese by their doctors, according to a new study led by Dana-Farber Cancer Institute researchers.
Weight "misperception" was most common among black men and women, and also was found among Hispanic men (but not women) compared to their white counterparts. The findings, which appear in the current online issue of the International Journal of Behavioral Nutrition and Physical Activity, are significant as excess body weight is a known risk factor for diabetes, heart disease, many forms of cancer, and premature death.
Growing concern over the national obesity epidemic in recent years apparently has not significantly increased overweight blacks' recognition of their excess pounds, said Gary G. Bennett, PhD, of Dana-Farber's Center for Community-Based Research and Harvard School of Public Health in Boston, lead author of the study.
The report by Bennett and Kathleen Y. Wolin, ScD, of Northwestern University is based on an analysis of data collected in the National Health and Nutritional Examination Survey (NHANES), a government-sponsored research study begun in the 1960s. It includes both interviews and physical examinations carried out by mobile units across the country.
Analyses of NHANES data collected in 1988-98 and 2001-02 show that the prevalence of misperception actually has increased among blacks. "During this period weve seen rapid gains in obesity," said Bennett. "We think it's a considerable problem that this is still not resonating among blacks and other minorities," he added.
Although the prevalence of overweight and obesity is even higher among blacks (estimated at over 75 percent) than the national average, Bennett said less pressure exists in the black community for people to lose weight through diet and exercise because of a cultural acceptance of higher body weights and heavier body shapes.
"We think that misperception can be very useful when it comes to protecting people against overly stringent body image ideals and eating disorders," said Bennett, who is black. "But it's a problem when people fail to realize the health consequences associated with obesity."
The researchers analyzed data on 6,552 overweight and obese men and women who participated in the 1999-2002 NHANES surveys. Included in the analyses were data on height, weight, body mass index, whether they had received a diagnosis of overweight from a doctor, and responses to the question, "Do you consider yourself now to be overweight, underweight, or about the right weight?" Since all the participants were overweight or obese by standard health guidelines, all answers of "about the right weight" were categorized as "inaccurate" or a "misperception" by the researchers. The study was not designed to determine whether the inaccurate statements were intentional or not.
The study found that men were more likely than women to misperceive their weight. Among women, the prevalence of misperception was highest among overweight black women (40.9 percent, compared to 20.6 percent in overweight white women) and men (66.4 percent, compared to 43.2 percent in overweight white men). It was lowest among obese white women (3.1 percent, compared with 11.2 percent in obese black women) and men (8.9 percent, compared to 26.2 of obese black men.)
Altogether, overweight black men and women were twice as likely as whites to make inaccurate body weight perceptions, and obese black adults were even more likely to exhibit weight status misperceptions, according to the report.
Unrealistic assessments of body weight were just as common in people who were relatively financially well off as in poorer people, and in those who had been told by their doctors that they were overweight or obese.
One lesson from the findings, Bennett said, is that "it is probably not sufficient for physicians to simply tell a person that he or she is overweight; doctors should do much more intensive counseling regarding the health consequence of being overweight."
The message is complicated, he added, by research findings showing that blacks generally don't experience life-shortening health effects until they are more obese compared to whites. "Obesity-associated mortality occurs at a higher BMI (body mass index) among blacks than it does for whites," probably for biological reasons, said Bennett. Yet some of the health effects associated with excess weight, such as diabetes, high cholesterol and hypertension, can be causing harm in blacks long before they result in death.
"The tendency to dramatically underestimate the degree of their overweight should be a clarion call to blacks," Bennett said. "We hope that people will increasingly recognize the health consequences associated with excess weight."
Overweight black Americans are two to three times more likely than heavy white Americans to say they are of average weight — even after being diagnosed as overweight or obese by their doctors, according to a new study led by Dana-Farber Cancer Institute researchers.
Weight "misperception" was most common among black men and women, and also was found among Hispanic men (but not women) compared to their white counterparts. The findings, which appear in the current online issue of the International Journal of Behavioral Nutrition and Physical Activity, are significant as excess body weight is a known risk factor for diabetes, heart disease, many forms of cancer, and premature death.
Growing concern over the national obesity epidemic in recent years apparently has not significantly increased overweight blacks' recognition of their excess pounds, said Gary G. Bennett, PhD, of Dana-Farber's Center for Community-Based Research and Harvard School of Public Health in Boston, lead author of the study.
The report by Bennett and Kathleen Y. Wolin, ScD, of Northwestern University is based on an analysis of data collected in the National Health and Nutritional Examination Survey (NHANES), a government-sponsored research study begun in the 1960s. It includes both interviews and physical examinations carried out by mobile units across the country.
Analyses of NHANES data collected in 1988-98 and 2001-02 show that the prevalence of misperception actually has increased among blacks. "During this period weve seen rapid gains in obesity," said Bennett. "We think it's a considerable problem that this is still not resonating among blacks and other minorities," he added.
Although the prevalence of overweight and obesity is even higher among blacks (estimated at over 75 percent) than the national average, Bennett said less pressure exists in the black community for people to lose weight through diet and exercise because of a cultural acceptance of higher body weights and heavier body shapes.
"We think that misperception can be very useful when it comes to protecting people against overly stringent body image ideals and eating disorders," said Bennett, who is black. "But it's a problem when people fail to realize the health consequences associated with obesity."
The researchers analyzed data on 6,552 overweight and obese men and women who participated in the 1999-2002 NHANES surveys. Included in the analyses were data on height, weight, body mass index, whether they had received a diagnosis of overweight from a doctor, and responses to the question, "Do you consider yourself now to be overweight, underweight, or about the right weight?" Since all the participants were overweight or obese by standard health guidelines, all answers of "about the right weight" were categorized as "inaccurate" or a "misperception" by the researchers. The study was not designed to determine whether the inaccurate statements were intentional or not.
The study found that men were more likely than women to misperceive their weight. Among women, the prevalence of misperception was highest among overweight black women (40.9 percent, compared to 20.6 percent in overweight white women) and men (66.4 percent, compared to 43.2 percent in overweight white men). It was lowest among obese white women (3.1 percent, compared with 11.2 percent in obese black women) and men (8.9 percent, compared to 26.2 of obese black men.)
Altogether, overweight black men and women were twice as likely as whites to make inaccurate body weight perceptions, and obese black adults were even more likely to exhibit weight status misperceptions, according to the report.
Unrealistic assessments of body weight were just as common in people who were relatively financially well off as in poorer people, and in those who had been told by their doctors that they were overweight or obese.
One lesson from the findings, Bennett said, is that "it is probably not sufficient for physicians to simply tell a person that he or she is overweight; doctors should do much more intensive counseling regarding the health consequence of being overweight."
The message is complicated, he added, by research findings showing that blacks generally don't experience life-shortening health effects until they are more obese compared to whites. "Obesity-associated mortality occurs at a higher BMI (body mass index) among blacks than it does for whites," probably for biological reasons, said Bennett. Yet some of the health effects associated with excess weight, such as diabetes, high cholesterol and hypertension, can be causing harm in blacks long before they result in death.
"The tendency to dramatically underestimate the degree of their overweight should be a clarion call to blacks," Bennett said. "We hope that people will increasingly recognize the health consequences associated with excess weight."
Fast Food and Black Neighborhoods
Fast Food Joints More Common in Poor, Black Neighborhoods. The high density of fast food outlets in low-income, majority black neighborhoods may contribute to the obesity epidemic, say Tulane University researchers.
“Where people live and the kinds of food available close to them is likely to affect their ability to have a healthy diet,” says senior author Karen DeSalvo, chief of general internal medicine at the Tulane University School of Medicine. “We found that high-income and mostly white neighborhoods have fewer fast food outlets per square mile than lower income or mostly black neighborhoods.”
Researchers used computer software to analyze the placement of fast food restaurants in Orleans Parish. The team found that predominantly black neighborhoods had 2.4 such eateries per square mile, while white neighborhoods only had 1.5, says lead author Jason Block, who is now an internal medicine physician at Brigham and Women's Hospital in Boston, Mass.
“We know that when people eat fast food, they often have larger portions with higher calorie counts than they do if they cook fresh food at home,” Block says. “We also know that obesity is increasingly a problem for low-income and black individuals.”
Access and the cost of food items do have an impact on what people eat, the authors wrote. DeSalvo and Block agree that more research is needed to examine the role of fast food in the obesity of low income and black populations.
The study is published in a recent issue of the American Journal of Preventive Medicine.
“Where people live and the kinds of food available close to them is likely to affect their ability to have a healthy diet,” says senior author Karen DeSalvo, chief of general internal medicine at the Tulane University School of Medicine. “We found that high-income and mostly white neighborhoods have fewer fast food outlets per square mile than lower income or mostly black neighborhoods.”
Researchers used computer software to analyze the placement of fast food restaurants in Orleans Parish. The team found that predominantly black neighborhoods had 2.4 such eateries per square mile, while white neighborhoods only had 1.5, says lead author Jason Block, who is now an internal medicine physician at Brigham and Women's Hospital in Boston, Mass.
“We know that when people eat fast food, they often have larger portions with higher calorie counts than they do if they cook fresh food at home,” Block says. “We also know that obesity is increasingly a problem for low-income and black individuals.”
Access and the cost of food items do have an impact on what people eat, the authors wrote. DeSalvo and Block agree that more research is needed to examine the role of fast food in the obesity of low income and black populations.
The study is published in a recent issue of the American Journal of Preventive Medicine.
Diabetes an Epidemic in Black America
by Kevin Chappell
Nearly 21 million people in the United States, or 7 percent of the population, have diabetes. And another 54 million people are believed to have the beginning stages of diabetes.
Every minute of every day, another American develops type 2 diabetes. Among African-Americans, the numbers are even more daunting. One in 7 Blacks has the disease, and African-Americans are twice as likely as Whites to develop diabetes.
At the rate that diabetes is progressing, it is predicted that for every two African-American children born today, one will develop diabetes--type 2 diabetes, which used to be called "adult onset diabetes."
But with more Black children than ever before being diagnosed with diabetes, medical professionals are rethinking their entire approach to the disease--and raising the question: Has diabetes become an epidemic in Black America?
"We're seeing shortening of life spans, people are dying earlier from heart disease, strokes," says Dr. Duane Smoot, chair of the medical department at the Howard University Hospital.
"There are just so many problems associated with diabetes. It causes aging of your blood vessels, so hardening of the arteries occurs more frequently. It causes people to have more problems with aging.
We talk about aging gracefully, but with this disease, it makes it more difficult to have a good quality of life. We have very firm data that tells us that diabetes itself had reached epidemic proportions in this nation as a whole, but more specifically in the African-American community."
Dr. Wayman Wendell Cheatham, medical director at the Medstar Research Institute in Washington, D.C., agrees. "We should be very, very concerned. I am terribly concerned," Cheatham says.
"Diabetes is a major killer. It doesn't only cause people to lose their vision, lose their kidneys, lose their limbs, diabetes reduces life expectancy significantly. People die of heart attacks and strokes because diabetes. It is one of the more underlisted causes of death of all causes ... With the trend line that we're on, it's a terrible epidemic."
Dr. James Gavin, past president of the American Diabetes Association, defines an epidemic as a disease that spreads "beyond a local population, lasting a long time and reaching people in a wider geographical area," he says. "Many classify diseases as a pandemic once the disease reaches worldwide proportions."
So what caused this explosion of diabetes in the Black community?
Gavin and others believe that genetics have played a large role. However, given that the population gene pool shifts very slowly overtime, the current epidemic of diabetes can't solely be attributed to genes.
Many health professionals are attributing a large part of the problem to the drastic slowing of active lifestyles, and the drastic shift in diet to one that now consists largely of processed foods.
The result: Black children and adults, particularly females, are more overweight now than ever before. One study on physical activity found that, by the age of 18, Black girls have a decline in physical activity twice that of White girls the same age.
"Obesity and diabetes go hand in hand," says Dr. Joyce Richey, diabetes researcher and assistant professor at the Keck School of Medicine at University of Southern California.
"The obesity issue is the trigger, and we have a genetic background that sets off that trigger. The result is a diabetes epidemic ... When you become obese, you become less responsive to the insulin that your body is putting out. Then your body realizes that you are becoming resistant, and starts putting out more insulin. Diabetes occurs when your beta cells become so impaired that you are not able to compensate for that resistance that you have."
Richey and other researchers are working feverishly to unravel the mystery of fat, particularly what is it about fat, or in fat, that triggers diabetes. "What we are finding out is that we've always thought of fat as being dormant, taking up space for sure, but not much else," she says.
"But what we are finding out [now] is that fat is like an organ that is secreting things into our system. Fat is not good, especially belly fat. That's the fat that is very unhealthy."
Richey says eating healthy and increasing physical activity are keys to stemming the diabetes epidemic. Catching the disease in its earliest stage is also key. When the disease is in its "pre-diabetes" stage, actions can be taken to prolong, if not prevent, its onset.
A landmark study sponsored by the National Institutes of Health indicated that people with pre-diabetes lowered their risk of developing type 2 diabetes by more than half by losing 5 to 7 percent of their body weight, getting at least 30 minutes of physical activity five days a week and eating healthier.
In addition to lifestyle changes, researchers are also developing new classes of drugs that decrease the rate of developing diabetes if taken early in the disease's progression. Other drugs restore the ability of the pancreas to make insulin more normally and release it more normally.
But presently, nothing can replace the self-determination of a person to keep his or her diabetes in check. Just ask Regina Barrett. The Washington, D.C., native has battled diabetes for five years. And so far, she's winning the fight.
"The changes that I have made are lifestyle changes," says the 51-year-old. "They are not temporary. They are things that, if I want to continue to feel good, if I want to do the best that I can, I have to do. I want to know that I have done all that I possibly can to fight the disease. Right now, I feel healthy, even having diabetes."
DIABETES By The Numbers
*DEATHS: Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2002. This ranking is based on the 73,249 death certificates in which diabetes was listed as the underlying cause of death. According to death certificate reports, diabetes contributed to a total of 224,092 deaths. Diabetes is likely to be underreported as a cause of death. Studies have found that only about 35 percent to 40 percent of decedents with diabetes had it listed anywhere on the death certificate and only about 10 percent to 15 percent had it listed as the underlying cause of death. Overall, the death rate among people with diabetes is about twice that of people without diabetes of similar age.
* HEART DISEASE AND STROKE: Heart disease and stroke account for about 65 percent of deaths in people with diabetes. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. The risk for stroke is 2 to 4 times higher among people with diabetes.
* HIGH BLOOD PRESSURE: About 73 percent of adults with diabetes have blood pressure greater than or equal to 130/80 millimeters of mercury (mm Hg) or use prescription medications for hypertension.
*BLINDNESS: Diabetes is the leading cause of new cases of blindness among adults aged 20 to 74 years. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.
*KIDNEY DISEASE: Diabetes is the leading cause of kidney failure, accounting for 44 percent of new cases in 2002. In 2002, 44,400 people with diabetes began treatment for end-stage kidney disease. In 2002, a total of 153,730 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant.
*NERVOUS SYSTEM DISEASE: About 60 percent to 70 percent of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems. Almost 30 percent of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling). Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.
*AMPUTATIONS: More than 60 percent of non-traumatic lower-limb amputations occur in people with diabetes. In 2002, about 82,000 non-traumatic lower-limb amputations were performed in people with diabetes.
*ESTIMATED COSTS OF DIABETES IN THE UNITED STATES: $132 billion, with $92 billion in direct medical costs and $40 billion in indirect costs (disability, work loss, premature mortality).
*TYPE 1 AND TYPE 2 DIABETES: Type 1 diabetes (also known as juvenile-onset diabetes) accounts for 5 percent to 10 percent of all people with diabetes. Type 2 diabetes accounts for the majority of people with diabetes--90 percent to 95 percent.
How DIABETES Is Ravaging The African-American Community
*Thirteen percent (3.2 million) of all African-Americans aged 20 years or older have diabetes.
*Twenty-five percent of African-Americans between the ages of 65 and 74 have diabetes.
*African-Americans are 1.8 times more likely than Whites to have diabetes.
*One in 4 African-American women over 55 years of age has diabetes.
*African-Americans are almost twice as likely as Whites to develop diabetic retinopathy (blindness).
*African-Americans are as much as 5.6 times more likely than Whites to suffer from kidney disease as a result of diabetes complications.
*African-Americans are 2.7 times more likely than Whites to suffer from lower-limb amputations.
Source: American Diabetes Association
Nearly 21 million people in the United States, or 7 percent of the population, have diabetes. And another 54 million people are believed to have the beginning stages of diabetes.
Every minute of every day, another American develops type 2 diabetes. Among African-Americans, the numbers are even more daunting. One in 7 Blacks has the disease, and African-Americans are twice as likely as Whites to develop diabetes.
At the rate that diabetes is progressing, it is predicted that for every two African-American children born today, one will develop diabetes--type 2 diabetes, which used to be called "adult onset diabetes."
But with more Black children than ever before being diagnosed with diabetes, medical professionals are rethinking their entire approach to the disease--and raising the question: Has diabetes become an epidemic in Black America?
"We're seeing shortening of life spans, people are dying earlier from heart disease, strokes," says Dr. Duane Smoot, chair of the medical department at the Howard University Hospital.
"There are just so many problems associated with diabetes. It causes aging of your blood vessels, so hardening of the arteries occurs more frequently. It causes people to have more problems with aging.
We talk about aging gracefully, but with this disease, it makes it more difficult to have a good quality of life. We have very firm data that tells us that diabetes itself had reached epidemic proportions in this nation as a whole, but more specifically in the African-American community."
Dr. Wayman Wendell Cheatham, medical director at the Medstar Research Institute in Washington, D.C., agrees. "We should be very, very concerned. I am terribly concerned," Cheatham says.
"Diabetes is a major killer. It doesn't only cause people to lose their vision, lose their kidneys, lose their limbs, diabetes reduces life expectancy significantly. People die of heart attacks and strokes because diabetes. It is one of the more underlisted causes of death of all causes ... With the trend line that we're on, it's a terrible epidemic."
Dr. James Gavin, past president of the American Diabetes Association, defines an epidemic as a disease that spreads "beyond a local population, lasting a long time and reaching people in a wider geographical area," he says. "Many classify diseases as a pandemic once the disease reaches worldwide proportions."
So what caused this explosion of diabetes in the Black community?
Gavin and others believe that genetics have played a large role. However, given that the population gene pool shifts very slowly overtime, the current epidemic of diabetes can't solely be attributed to genes.
Many health professionals are attributing a large part of the problem to the drastic slowing of active lifestyles, and the drastic shift in diet to one that now consists largely of processed foods.
The result: Black children and adults, particularly females, are more overweight now than ever before. One study on physical activity found that, by the age of 18, Black girls have a decline in physical activity twice that of White girls the same age.
"Obesity and diabetes go hand in hand," says Dr. Joyce Richey, diabetes researcher and assistant professor at the Keck School of Medicine at University of Southern California.
"The obesity issue is the trigger, and we have a genetic background that sets off that trigger. The result is a diabetes epidemic ... When you become obese, you become less responsive to the insulin that your body is putting out. Then your body realizes that you are becoming resistant, and starts putting out more insulin. Diabetes occurs when your beta cells become so impaired that you are not able to compensate for that resistance that you have."
Richey and other researchers are working feverishly to unravel the mystery of fat, particularly what is it about fat, or in fat, that triggers diabetes. "What we are finding out is that we've always thought of fat as being dormant, taking up space for sure, but not much else," she says.
"But what we are finding out [now] is that fat is like an organ that is secreting things into our system. Fat is not good, especially belly fat. That's the fat that is very unhealthy."
Richey says eating healthy and increasing physical activity are keys to stemming the diabetes epidemic. Catching the disease in its earliest stage is also key. When the disease is in its "pre-diabetes" stage, actions can be taken to prolong, if not prevent, its onset.
A landmark study sponsored by the National Institutes of Health indicated that people with pre-diabetes lowered their risk of developing type 2 diabetes by more than half by losing 5 to 7 percent of their body weight, getting at least 30 minutes of physical activity five days a week and eating healthier.
In addition to lifestyle changes, researchers are also developing new classes of drugs that decrease the rate of developing diabetes if taken early in the disease's progression. Other drugs restore the ability of the pancreas to make insulin more normally and release it more normally.
But presently, nothing can replace the self-determination of a person to keep his or her diabetes in check. Just ask Regina Barrett. The Washington, D.C., native has battled diabetes for five years. And so far, she's winning the fight.
"The changes that I have made are lifestyle changes," says the 51-year-old. "They are not temporary. They are things that, if I want to continue to feel good, if I want to do the best that I can, I have to do. I want to know that I have done all that I possibly can to fight the disease. Right now, I feel healthy, even having diabetes."
DIABETES By The Numbers
*DEATHS: Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2002. This ranking is based on the 73,249 death certificates in which diabetes was listed as the underlying cause of death. According to death certificate reports, diabetes contributed to a total of 224,092 deaths. Diabetes is likely to be underreported as a cause of death. Studies have found that only about 35 percent to 40 percent of decedents with diabetes had it listed anywhere on the death certificate and only about 10 percent to 15 percent had it listed as the underlying cause of death. Overall, the death rate among people with diabetes is about twice that of people without diabetes of similar age.
* HEART DISEASE AND STROKE: Heart disease and stroke account for about 65 percent of deaths in people with diabetes. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. The risk for stroke is 2 to 4 times higher among people with diabetes.
* HIGH BLOOD PRESSURE: About 73 percent of adults with diabetes have blood pressure greater than or equal to 130/80 millimeters of mercury (mm Hg) or use prescription medications for hypertension.
*BLINDNESS: Diabetes is the leading cause of new cases of blindness among adults aged 20 to 74 years. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.
*KIDNEY DISEASE: Diabetes is the leading cause of kidney failure, accounting for 44 percent of new cases in 2002. In 2002, 44,400 people with diabetes began treatment for end-stage kidney disease. In 2002, a total of 153,730 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant.
*NERVOUS SYSTEM DISEASE: About 60 percent to 70 percent of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems. Almost 30 percent of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling). Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.
*AMPUTATIONS: More than 60 percent of non-traumatic lower-limb amputations occur in people with diabetes. In 2002, about 82,000 non-traumatic lower-limb amputations were performed in people with diabetes.
*ESTIMATED COSTS OF DIABETES IN THE UNITED STATES: $132 billion, with $92 billion in direct medical costs and $40 billion in indirect costs (disability, work loss, premature mortality).
*TYPE 1 AND TYPE 2 DIABETES: Type 1 diabetes (also known as juvenile-onset diabetes) accounts for 5 percent to 10 percent of all people with diabetes. Type 2 diabetes accounts for the majority of people with diabetes--90 percent to 95 percent.
How DIABETES Is Ravaging The African-American Community
*Thirteen percent (3.2 million) of all African-Americans aged 20 years or older have diabetes.
*Twenty-five percent of African-Americans between the ages of 65 and 74 have diabetes.
*African-Americans are 1.8 times more likely than Whites to have diabetes.
*One in 4 African-American women over 55 years of age has diabetes.
*African-Americans are almost twice as likely as Whites to develop diabetic retinopathy (blindness).
*African-Americans are as much as 5.6 times more likely than Whites to suffer from kidney disease as a result of diabetes complications.
*African-Americans are 2.7 times more likely than Whites to suffer from lower-limb amputations.
Source: American Diabetes Association
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