Diabetes, Obesity and Disparities
Nearly 1.5 million California adults —5.9 percent of the population— has been diagnosed with diabetes. African Americans, Latinos, Native Americans and Alaska Natives are diagnosed with diabetes at far higher rates than whites. Children with a family history of diabetes and those who are members of ethnic or racial groups at risk for diabetes experience an increased risk of the disease.
With so many youth at risk, it is not surprising that the last decade has seen a dramatic rise in the rate of pediatric Type 2 diabetes in the United States. Before 1992, Type 2 diabetes accounted for 2-4 percent of all childhood diabetes cases. More recent numbers estimate that up to 45 percent of all new childhood diabetes diagnoses is Type 2 diabetes. Among children diagnosed with Type 2 diabetes, 80 percent are overweight. In California, 24 percent of adolescent's ages 12 to 17 are overweight or at risk for being overweight, with African American and Latino adolescents having higher rates of overweight than whites and Asians. Experts now predict that one in every four Latino and African-American babies born in California will develop diabetes in their lifetime.
The combination of overweight and physical inactivity results in significant medical and financial resources being expended in the treatment of overweight youth and obese adults. As the percentage of children who are overweight rises, and as these children age, the health problems they face will burden California with growing costs for medical care and lost productivity. In 2000, the estimated national costs attributable to obesity amounted to $118 billion.
Nutrition and Physical Activity Disparities Framework
The scientific literature suggests that the high prevalence of overweight and physical inactivity is caused by numerous individual, social and environmental factors. Historically, strategies to reduce obesity and diabetes have focused exclusively on a traditional medical model of individual behavior modification and treatment. These approaches have not been successful because they often ignore the context in which individual choices are made. While individual knowledge of health risks and behavior remains an essential ingredient in obesity prevention, recent studies have linked the epidemic to environmental conditions including, but not limited to, the following:
- Increasing portion sizes
- Increasing consumption of fast food and soft drinks
- Availability of soda and junk food on school campuses, including preschools and after school programs
- Lack of physical activity opportunities in schools and communities
- Limited compliance with physical education requirements in many schools
- Too much time spent watching television or playing video games
- Limited access to healthy foods in low-income neighborhoods
- Advertising of junk food to children and their families
- Lack of preventive strategies, training and preventive tools in the health care arena
The social, economic and physical environments in which people live create the context for decision-making about diet and physical activity. Immense disparities exist between the nutrition and physical activity environments of communities of color, low-income populations and those of higher income whites, which makes it difficult for many to adopt healthy lifestyles. Food consumption is based on both preference and availability. Many low-income communities lack supermarkets that sell a wide array of healthy foods, making it more difficult for consumers to make healthy food choices. Many of these same communities do not have the green space or safety that allow residents to participate in physical activity in their neighborhood. The disparity in community food and physical activity resources is contributing to high levels of diseases related to poor nutrition and lack of physical activity, like obesity and diabetes.
In order to address the health disparities related to diet and physical activity, it is essential that programs and policies focus on the community environment in which individuals live, work, go to school and play. While the community environment has an impact on the health of individuals, members of the community often lack the resources to address the disparities in their neighborhood, particularly in low-income communities and communities of color.
While no single factor has been identified as the primary cause of the childhood obesity epidemic, it is the constellation of these factors that fuels the rising rates of childhood obesity and diabetes. The entanglement of social, environmental and behavioral factors presents a complex challenge when identifying targeted strategies aimed at addressing the problem.
For more information about the full complement of work that The California Endowment is doing on Health Disparities, go to: http://www.calendow.org/Category.aspx?id=308&ItemID=308
