Beyond Obesity: Reframing Food Justice with Body Love « Oakland …

Oakland has been at the forefront of what many would call the food justice movement – a movement to ensure that disenfranchised communities have power over they foods they produce, sell and eat.  Organizations like People’s Grocery have led the way in identifying the intersections between race, income and health.  Phat Beets Produce and City Slicker Farms have been innovators in community-led urban gardening.

Being in one of the centers of food justice work has been exciting but as someone who has also been involved in body acceptance movement, I find myself increasingly uncomfortable with the frame of obesity prevention as a justification some use to enter this great work.  Many groups doing this work have to apply for funding (such as Michelle Obama’s Let’s Move) that frames food access as obesity prevention.  Researcher Linda Bacon coined the term “Health at Every Size” to challenge ideas that weight loss is desirable for everyone and I wanted to think further about the impact of the framework of obesity prevention of food justice and communities of color.  That’s when I read Sonya Renee’s post  Weight Stigma in Diverse Populations.

Sonya-Renee-Taylor-2

By stating “Our society tells us fatness is not beautiful.  Blackness is historically, not beautiful.  So even while battling weight stigma and reclaiming size diversity as beautiful, the presence of Blackness complicates the narrative,” Sonya Renee names the very real intersection between marginalization of women of size and black women.  Performance Poet, Activist and transformational leader, Sonya Renee is a National and International poetry slam champion, published author, and change maker.  As the founder and CEO of the The Body is Not An Apology, she is working to promote an international movement focused on radical self love and body empowerment. I asked Sonya more about the impact of the obesity prevention frame on food justice work.  Her responses are eye opening.

There are a lot of well-meaning people trying to do right by their communities by working on “food justice.”  Does that have relevance to size acceptance and body love?  Where do you see the intersections?  

I think food justice absolutely has relevance to size acceptance and body love or what The Body is Not An Apology calls Radical Self Love.  Radical Self Love is about being an advocate for your own well-being, your body and then allowing that advocacy to demand those things that aid well-being.  Asking for healthy food and access to nutrition is without question an element of radical self-love.  Also, when we think about who has access to good grocery stores, nutritious choices in their communities; we must look at the ways body impacts that.  There is a racial aspect that must be named which is about what bodies are valued and cared for systemically and which we do not. Those observations lead us directly to the way we further disenfranchise bodies of color, fat bodies, poor bodies.  Food justice is about ensuring all bodies have access and autonomy over their bodies.

How do community activists combat the obesity frame in public health, especially related to black communities?  There’s some real dollars attached to doing food justice as “combating obesity.”

I think it is essential to talk about the intersections of discrimination.  Asking how is a framework that makes someone’s body “wrong” an act of public health? We must ask who benefits from a war against people’s bodies.  Does it benefit communities to be at war with their bodies?  Does it benefit large people to view their bodies as a thing they must fight?  If the benefit is not to the communities we serve then what makes the model a justice movement?  Given that there are actual health indicators that can be assessed without size and size actually is not valid indicator of health unto itself, it is completely possible to talk about health without pathologizing bodies.  I also challenge public health professionals to be honest about the mental health aspects of having society be at war with your body or teaching people to be at war with themselves which is the translation of “combating obesity.”  Anything that reinforces inequity, bigotry, prejudice or shame IS NOT a justice movement.  Food justice work that does not include dismantling weight stigma in my opinion is not a justice movement.

There’s a lot of momentum around promoting health in marginalized communities (i.e. Michelle Obama’s work) but with the frame of ending obesity.  What frame would you recommend using to address what are real problems of accessibility for food and recreation? 

I often just sit with the idea that the “ending obesity” paradigm is actually saying “we want to end Fat People.”  There simply is no health promotion in that framework.  The Body is Not An Apology operates from the framework that says injustice starts in many ways from the inability to make peace with the body, our own and others.  From that premise, the issue of promoting health is not about the failure of the body but the failure of our society to protect and care for EVERY BODY equally and the ways in which we as individuals and communities have internalized that lack of care.  If we cared for each person in our society we would have those things that are required for basic human sustainability in all communities.  We would have grocery stores with affordable healthy options; we would have playgrounds and recreation in all communities.  If we did not have recreation due to community violence we would be addressing and healing community violence.  We would be ensuring our media replicated images of all members of society in nuanced, dynamic, psychological healthy ways.  If we were using an intersectional community care model we would be addressing the myriad ways we could better care for each other and for ourselves.

How do we incorporate the historical analysis of the commodification of black bodies into our work as food justice advocates?

Understanding the commodification of black bodies helps understand why there is little investment in our community’s well-being and health.  I think it would also help black people understand how their demand to be treated humanely via Food Justice is as vital as the Civil Rights movement, abolition movement etc.  The value of black bodies was directly tied to unpaid labor.  When that unpaid labor was no longer a resource, we saw a complete divestment in the lives of black people.  Now that the commodification of black bodies comes via the criminal justice system there is an absolute necessity to foster the disrepair of black communities. The commodification depends on us growing up in such a way that increases our likelihood of engaging in criminal activity.  That is shown time and again to be directly tied to poverty and not having one’s basic needs met.  Food justice is about ensuring that all communities have their basic needs met so that they might thrive. The treatment of people in such communities is an illustration of the difference between commodifying bodies and valuing bodies. Food Justice is about demanding our bodies be valued!

Finally, how do we make the shift from shame and blame to love?

The question I ask that gets me to the answer of that question is always about who does blame and shame serve?  How does blame and shame make a world that creates positivity and possibility?  I reject the notion that there is some way that my body can be wrong.  And if there is nothing wrong with my body then there is no place for blame or shame.  From this space I can focus on how I can better LOVE my body and how I can better advocate that the world support me, my family, and my community in growing that love.

Obesity in children: What is the responsibility of doctors?

Lying in a hospital bed, my seriously obese patient could barely see her swollen and odorous right foot over her abdominal fat. The foot was soon to be amputated, the result of an untreatable infection exacerbated by diabetes and kidney failure, which developed in part because of obesity.Her two children, ages 6 and 12, hovered from the hospital bed to the couch. In between, the bedside table was strewn with empty fast-food bags, pastry crumbs and large soda cups.

Like their mother, the children were exceedingly overweight.The mother was in her 30s; I had all but given up hope for her long-term survival. And as I watched her children, I feared for their health.

Childhood obesity is a recent disease. During medical school in the late 1980s, I do not recall a single lecture or patient case presentation on the subject. But much has changed; in just the past two decades, obesity among children has more than doubled, from 7 percent to 18 percent, and among adolescents it has more than tripled, from 5 percent to 18 percent. These children are more likely to have pre-diabetes, bone and joint problems, sleep apnea, and risk factors for cardiovascular disease.

Certainly parents have responsibility here. But I often wonder: What is the responsibility of the medical establishment?

Three months ago, the American Medical Association recognized obesity as a disease. We doctors are now struggling to figure out our role in treating this newly declared illness — and how to approach children and their parents about healthy eating and exercise habits that will last a lifetime.

When I spoke about this with a pediatrician in my community near Memphis, she sounded discouraged. In a typical case of an overweight teenager, she said, “I show the mother the growth curve and point out that the child is way off the charts. Then I ask, ‘Have you thought about controlling the weight?’

“First there is denial,” she said. “And often there is the blame game — it’s the grandma or the dad” who overindulges the child. This isn’t a problem that is easily solved in a doctor’s office, she said.

One tool in her limited kit is something called “5210 Every Day.” Adapted from a program that originated in Maine and is spreading nationwide, 5210 promotes four “numbers to live by”: Kids should eat 5 or more servings of fruit and vegetables a day; spend 2 hours or less on recreational screen time; get 1 hour or more of physical activity; and consume 0 sugary drinks.

She explains the program to her patients and sends them home with a 5210 brochure.

brochure? “How much can I do in 15 minutes?” the pediatrician said. That’s how long she has to tend to the problem that prompted the visit, plus provide other counseling: vaccinations, drinking, drugs, sexually transmitted diseases, bicycle helmets, and yes, diet and exercise. And it may be another year before she sees the youngster again.

I understand the pediatrician’s quandary. For one thing, how do you tell a mother to send her children outside to play if their street has boarded-up windows and drug dealers on the corner? How hard is it for her to buy and prepare fresh foods? In other situations, where families are fortunate enough to live in a safe neighborhood and have plenty of fruit and vegetables in the refrigerator, we see some parents who are too worried about their children’s self-esteem to talk to them about their weight.

The medical community is taking some concrete steps: For example, childhood-obesity clinics are popping up at academic centers nationwide. The head of pediatrics at one such center tells me a team approach is used to help young patients manage diabetes and hypertension — a nutritionist, a physical therapist, a social worker, a psychologist and pediatric specialists. But he acknowledges that few private pediatrics offices have all these resources. A broader problem is getting Medicaid and private insurers to reimburse doctors for obesity counseling.I fear that we will not come close to solving this problem anytime soon.

Here in Memphis — named the fattest big city in the United States in a 2011 Gallup study – I see a root cause of childhood obesity every time I make the drive to one of my hospitals: Take a left turn at the Krispy Kreme Doughnuts and the Burger King, just after the McDonald’s and before the Wendy’s, Taco Bell and Pizza Hut — which are all on the same road as a famous local fried chicken place with a billboard advertising a $5 meal. Our children are growing up among land mines disguised as play areas.

These are some ironies of our society and health system: We allow our children to be poisoned by excessive high-sugar, high-fat foods and then we treat them for the diseases that are caused in part by such foods. We spare no expense to save a baby’s life, yet we’re not willing to reimburse doctors for nutritional and social counseling if that baby grows into an obese child.The U.S. health-care system is designed to function best when doctors are treating acute illnesses, such as a heart attack or pneumonia. Slowly it is being pushed to provide better treatment for chronic illnesses such as diabetes. But it still misses the mark on prioritizing and promoting preventive and lifestyle changes.

For a moment I imagine a health-care system in which reimbursement is not based entirely on the sickness of the patient but is partly based on what experts call “population health.” Doctors, hospitals, insurance companies, pharmaceutical firms and home health agencies would be paid not only for treating individuals’ illnesses but for demonstrating that they had advanced and maintained the health and wellness of the community.

It would be a gigantic shift. Still, I am hopeful: Much is happening to turn the tide. First lady Michelle Obama is leading the “Let’s Move” campaign, which is placing awareness of childhood obesity on the public agenda. New York Mayor Michael R. Bloomberg (I) is trying to limit the size of sugary drinks. And the 5210 campaign and similar programs are spreading to more and more cities.

Here in Tennessee, a community campaign supported by Healthy Memphis Common Table – a regional health collaborative that I helped found a decade ago — appears to have had some encouraging results. The campaign works with local farmers markets, schools and beverage companies; one of its efforts led to junk food being banned from the vending machines in elementary schools, and another turns vacant lots into thriving gardens. The preliminary results of a study by Vanderbilt University School of Medicine indicate that the rate of obesity among adults here has dropped below the state average, whereas more thank a decade ago the rate was 5 percent above the state average.

We doctors must look upstream to the causes of obesity and get creative about our role.

As I stood in my patient’s room, where the odor of rotting flesh mixed with the aroma of leftover French fries, I considered her life-threatening infection, preceded by kidney failure and diabetes, which were preceded in turn by a massive weight gain that did not have to happen. I realized she would not live as long as her mother had, and I recalled studies that have predicted that for the first time in U.S. history, children have a shorter life expectancy than their parents, largely because of obesity-related conditions.

The woman I cared for in that hospital died a year later from complications of diabetes, renal failure, hypertension and obesity. It’s her children who need help now.

Manoj Jain is an infectious disease physician and contributor to the Washington Post, where this article originally appeared, and The Commercial Appeal.  He can be reached at his self-titled site, Dr. Manoj Jain.

Facebook interests could help predict track and map obesity | News …

Study correlates data on Facebook users’ interests with obesity rates in cities and towns nationally and in New York City neighborhoods

April 24, 2013

Boston, Mass.—The higher the percentage of people in a city, town or neighborhood with Facebook interests suggesting a healthy, active lifestyle, the lower that area’s obesity rate. At the same time, areas with a large percentage of Facebook users with television-related interests tend to have higher rates of obesity. Such are the conclusions of a study by Boston Children’s Hospital researchers comparing geotagged Facebook user data with data from national and New York City-focused health surveys.

Together, the conclusions suggest that knowledge of people’s online interests within geographic areas may help public health researchers predict, track and map obesity rates down to the neighborhood level, while offering an opportunity to design geotargeted online interventions aimed at reducing obesity rates.

The study team, led by Rumi Chunara, PhD, and John Brownstein, PhD, of Boston Children’s Hospital’s Informatics Program (CHIP), published their findings on April 24 in PLOS ONE.

The amount of data available from social networks like Facebook makes it possible to efficiently carry out research in cohorts of a size that has until now been impractical. It also allows for deeper research into the impact of the societal environment on conditions like obesity, research that can be challenging because of cost, difficulties in gathering sufficient sample sizes and the slow pace of data analysis and reporting using traditional reporting and surveillance systems.

“Online social networks like Facebook represent a new high-value, low-cost data stream for looking at health at a population level,” according to Brownstein, who runs the Computational Epidemiology Group within CHIP. “The tight correlation between Facebook users’ interests and obesity data suggest that this kind of social network analysis could help generate real-time estimates of obesity levels in an area, help target public health campaigns that would promote healthy behavior change, and assess the success of those campaigns.”

To connect the dots between Facebook interests and obesity, Chunara, Brownstein and their colleagues obtained aggregated Facebook user interest data—what users post to their timeline, “like” and share with others on Facebook—from users nationally and just within New York City. They then compared the percentages of users interested in healthy activities or television with data from two telephone-based health surveys: the US Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System-Selected Metropolitan/Micropolitan Area Risk Trends (BRFSS-SMART), and New York City’s EpiQuery Community Health Survey (CHS). Both surveys record geotagged data on body mass index, a reliable measure of obesity.

The comparison revealed close geographic relationships between Facebook interests and obesity rates. For instance, the BRFSS-SMART obesity rates were 12 percent lower in the location in the United States where the highest percentage of Facebook users expressing activity-related interests (Coeur d’Alene, Idaho) compared that in the location with the lowest percentage (Kansas City, Mo.-Kan.). Similarly, the obesity rate in the location with the highest percentage of users with television-related interests nationally (Myrtle Beach-Conway-North Myrtle Beach, S.C.) was 3.9 percent higher than the location with the lowest percentage (Eugene-Springfield, Ore.).

The same correlation was reflected in the New York City neighborhood data as well, showing that the approach can scale from national- to local-level data. The CHS-reported obesity rate on Coney Island, which had the highest percentage of activity-related interests in the city, was 7.2 percent lower than Southwest Queens, the neighborhood with the lowest percentage. At the same time, the obesity rate in Northeast Bronx, the neighborhood with the highest percentage of television-related interests, was 27.5 percent higher than that in the neighborhood with the lowest percentage (Greenpoint). 

 

Relating proportion of activity-related “likes”
on Facebook with obesity rates

 

Region with lowest percentage

Region with highest percentage

? obesity rate between lowest and highest

Nationally

Kansas City, Mo.-Kan. (1.3%)

Coeur d’Alene, Idaho (25.4%)

-12%

NYC

Southwest Queens (7.6%)

Coney Island
(11.2%)

-7.2%

  

 

Relating proportion of television-related “likes”
on Facebook with obesity rates

 

Region with lowest percentage

Region with highest percentage

? obesity rate between lowest and highest

Nationally

Eugene-Springfield, Ore. (50.3%)

Myrtle Beach-Conway-North Myrtle Beach, S.C. (76%)

+3.9%

NYC

Greenpoint (64%)

Northeast Bronx (70.6%)

+27.5%

 “The data show that in places where Facebook users have more activity-related interests, there is a lower prevalence of obesity and overweight,” said Chunara, an instructor in Brownstein’s group. “They reveal how social media data can augment public health surveillance by giving public health researchers access to population-level information that they can’t otherwise get.”

The study also bolsters the case for using social media as a means of delivering targeted interventions aimed at reducing rates of obesity and other chronic diseases, as applicable.

The study was supported by the National Library of Medicine (grants G08LM009776, and R01LM010812) and Google.org.

Contact:
Keri Stedman
617-919-3110
keri.stedman@childrens.harvard.edu

Boston Children’s Hospital is home to the world’s largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 1,100 scientists, including nine members of the National Academy of Sciences, 11 members of the Institute of Medicine and 11 members of the Howard Hughes Medical Institute comprise Boston Children’s research community. Founded as a 20-bed hospital for children, Boston Children’s today is a 395-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Boston Children’s also is a teaching affiliate of Harvard Medical School. For more information about research and clinical innovation at Boston Children’s, visit: http://vectorblog.org/.

The Obesity of North American Transportation | Tour d'Afrique Ltd.

The Obesity of North American Transportation

ObesityinfogramFINALObesityinfogramFINAL

We all use cars. Many of us own cars, in some cases more than one. But private automobiles, as with many technological advances, are a bit of Faustian deal, defined in the dictionary as “a bargain made or done for present gain without regard for future cost or consequences”.

For the last century cars have been marketed to us as wonderful devices that will bring us happiness, comfort, sex, freedom, efficiency – you name it. Whole economies and much personal wealth have been built around cars. The best minds in advertisements have used every possible approach they could think of to sell us on cars. And for a long time it has worked, and to a large degree it still does.

_c232656_image_0But, of course, there is a cost to the car –a very serious one. A disturbing result of using a car too often is obesity. Every day I cycle to work noticing that just about every car I pass has a single occupant driving to work, yet the cars were all built for five passengers or more. Each of those cars has an engine built for much more effort than to drive one individual at a maximum speed of 60 km (or 40 miles) an hour (speed limits in most cities). And then it hit me, our North American transportation system is itself obese. Like human obesity, it is slowly killing us. Thus, the Faustian bargain.

So here in the office, we thought that we could represent this cost in an infographic, one with a bit of humour, in the hope that this will add to the critical mass that is building to change this model of transportation; a model which has spread around the world. One that has not been the most efficient nor the best for the planet nor for the health of the people who own cars.

Please feel free to share it, print it or tweet it.

ObesityinfogramFINAL

Gohmert calls for more guns because obesity isn't caused by 'too …

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Louie Gohmert speaks to Newsmax

Rep. Louie Gohmert (R-TX) responded to Monday’s shooting at the Washington Navy Yard by calling for more people to be armed, and insisted that blaming guns was like saying that obesity was caused by “too many spoons.”

In an interview on Tuesday, Newsmax’s John Bachman asked the Texas Republican if Congress should be talking about overhauling the mental health system in response to the Navy Yard tragedy.

“I absolutely do,” Gohmert agreed. “It obviously has an effect, and it’s interesting that these people seem to have a common tie with extremely violent video games.”

“But it is important to note that it is our own system that’s breaking down,” he added. “How in the world do you give a legitimate ID to a guy who got ousted out of the Navy for gunfire incidents? I mean, good night. How do you give this guy access to anything?”

The congressman said that he would be “all for everybody keeping their sidearms if they’re in the military and on a military installation. That’s something we need to get back to.”

“I see a lot of problems here and blaming this on guns is like saying the big problem with obesity is we’ve got too many spoons,” he opined. “It’s not the spoons, it’s not the guns. It’s the people who have them.”

“There’s a lot of things that need to be done, but one of them is to deal with the mental health of people who have guns.”

Watch the video below from Newsmax, broadcast Sept. 17, 2013.

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Madison Clinic Helps Young Diabetes Patients Manage Their Own Care

When children are diagnosed with type 1 diabetes­ – one of the most common chronic conditions of childhood – parents typically shoulder the burden of managing their care.  

This includes a rigorous daily routine of supervising what the child eats, checking blood sugar levels, administering insulin and keeping regular medical appointments. It’s a big job, and as children become independent adults, it’s one they must gradually take upon themselves. 

The Madison Clinic aims to improve the lives of patients and their families and to ease the burden of diabetes through compassionate and individualized management with emphasis on education, empowerment, and use of advanced technologies.

Visit the clinic’s website for more information.

This process of “transition” is important for maintaining optimal health, and it is highly influenced by socio-economic and cultural factors.

UCSF psychologist Diana Naranjo, PhD, an assistant professor of pediatrics, is particularly interested in how the health care transition occurs in ethnic minority families. Her work is part of a broad effort to smooth the transition process for all young adult patients at the Madison Clinic for Pediatric Diabetes at UCSF Benioff Children’s Hospital.

An Extra Developmental Challenge

Patients in the transitional age group­­ – 18 through 30 – face special challenges when it comes to managing their diabetes.

Diana Naranjo, PhD

“Young adults, who are still evolving decision-making skills, often feel ‘I’ve been dealing with this my whole life. I want it to go away,’” said Naranjo. 

An autoimmune disorder in which the body attacks the pancreas, type 1 diabetes requires that patients take over the metabolic balancing act that this organ performs in healthy individuals. That requires a daunting series of tasks that must be performed every day. If poorly controlled, the disease can cause serious short and long-term consequences.

Managing type 1 diabetes often conflicts with normal developmental behaviors, said Naranjo.

Experimentation with drinking alcohol, for example, has extra risks for youth with diabetes because it can affect blood sugars and impair judgment. Young people may also struggle with how to disclose the demands of their disease when starting an intimate relationship.

Guiding the Transition Process

The Madison Clinic is working to ease the transition process for all its young adult patients. These efforts are led by a team that includes pediatric diabetes specialists Saleh Adi, MD and Stephen Gitelman, MD, endocrinologist Roger Long, MD, and Megumi Okumura, MD, a specialist in chronic disease management.

Patients complete an annual survey that Naranjo and the team have developed that helps identify how much teen and young adult patients know about their disease – with questions about their knowledge of medical management, insurance, sex and drugs. 

Transition coordinator Marcela Arregui-Reyes sits down with every patient age 16 or older to complete the survey and prioritizes specific areas where more education is needed.  With most patients making four visits to the clinic each year, the goal is to fill in the most important educational gaps at each visit.

How Transition Differs for Minority Families

Ethnic minority patients in the transitional age group often wrestle with additional challenges, according to Naranjo.

As they reach adulthood and age out of public healthcare systems for children with chronic illness, some may be left uninsured or with very limited healthcare options.  This can lead to poor diabetes management and higher utilization of emergency room services.

Madison Clinic for Pediatric Diabetes at UCSF’s Mission

Bay campus

Naranjo, who is fluent in Spanish, has a special interest in cultural differences in patients’ perceptions about diabetes and its care.  

The Madison Clinic serves a higher-than-average percentage of minority patients with type 1 diabetes, making it a good site for researching these differences. Roughly 25 percent of the clinic’s families are Latino, and African-American families are proportionately higher than in the overall U.S. population of patients with diabetes.

Naranjo has gathered detailed information from 20 clinic families so far, using a combination of surveys and in-depth interviews with patients and family members.  One emerging pattern, according to Naranjo, is that Latino parents do not necessarily value transition in the same way that the medical world does.  The transition model used in medical settings is designed to help young adults take over monitoring their health, making their own appointments and interfacing with insurance companies or other agencies.  

“Latino parents often wonder ‘Why should I burden my child in that way?’” said Naranjo.  Many Latino families continue living together longer into adulthood than non-Latino families, and consequently, parents continue to play a big role in their young adult’s diabetes management.

Latino children may also look at the transition process differently, particularly if their parents are uninsured and struggling to treat their own chronic health problems, such as high blood pressure or type 2 diabetes.

Naranjo will continue her research in the coming year. In the meantime, her findings suggest that health transition specialists may need to tailor the information they give to minority families to match different perceptions of living with a chronic disease.

Diabetes Ailing 114 Million Chinese Risks Ravaging Budget

Diabetes may consume $22 billion,
or more than half of China’s annual health budget, if all those
afflicted with the condition get routine, state-funded care.

The disease is putting an “overwhelming burden” on the
country, according to the International Diabetes Federation,
which says China spent $17 billion, or about $194 a patient, on
diabetes last year. A study released last week found China has
114 million diabetics or 21.6 million more than the Brussels-based federation estimated in November.

Extending average care to the enlarged population of
diabetes sufferers would wipe out all of China’s additional
investment in health. The government budgeted spending 260.25
billion yuan ($42.5 billion) this year, a 27 percent increase,
on basic medical services and subsidies for a state-run health
insurance program. China’s diabetes costs will balloon, with
almost 500 million Chinese at risk of developing the disease.

“It’s very scary,” said T.H. Lam, a professor of public
health at the University of Hong Kong. “This only represents
the beginning of the diabetic epidemic. The worst is yet to
come.”

Diabetes costs an average of $1,270 per patient globally
and $8,478 in the U.S., according to the International Diabetes
Federation
. Treatment for the metabolic condition and its
associated ailments is expensive because patients with poor
blood-sugar control can develop complications ranging from heart
disease
and stroke to gangrenous foot ulcers, blindness and
kidney failure.

Oblivious Diabetics

The most comprehensive nationwide survey for diabetes ever
conducted in China showed 11.6 percent of adults have the
disease. The study, published Sept. 3 in the Journal of the
American Medical Association
, also found that almost two-thirds
of patients treated for diabetes in China don’t have adequate
blood-sugar control and that for every person diagnosed with the
condition, at least two more will be unaware they have it.

“People with diabetes who are not under treatment or have
good control of their diabetes will quickly start to develop
complications,” said Leonor Guariguata, a biostatistician at
the International Diabetes Federation. “We know from studies in
Europe that the first cardiovascular complication in a person
with diabetes can increase the per-person annual costs
associated with the disease by at least 50 percent and by 360
percent for a major cardiovascular event, such as heart attack
or stroke.”

$500 Billion Cost

Type-2 diabetes prevalence is expanding 4 percent a year
globally, compared with 1-to-2 percent for obesity, resulting in
$500 billion in medical costs, or more than 10 percent of
health-care expenditure, the Credit Suisse Research Institute
said yesterday in a report. Ninety percent of doctors worldwide
surveyed by the institute believe the type-2 diabetes and
obesity epidemics are linked to excess sugar consumption.

“As with alcohol and tobacco, higher taxation on drinks is
the best option to reduce sugar intake and help fund the fast
growing health-care costs,” the report said.

Most of China’s diabetes sufferers have the type-2 form,
which occurs when the body stops responding adequately to
insulin, the hormone that regulates blood-sugar. Type-1
diabetes, prevalent in about 5 percent of all sufferers, is an
autoimmune disease that results from the destruction of the
body’s insulin-producing beta cells in the pancreas.

China’s diabetes prevalence is being spurred by diet and
lifestyle changes linked to the country’s economic development,
which have resulted in an increasingly overweight and obese
population, said Barry Popkin, a professor in the department of
nutrition at the University of North Carolina at Chapel Hill,
who has studied weight trends in China.

‘Tip of the Iceberg’

“This is just the tip of the iceberg,” Popkin said in an
interview. “We’re beginning to see a whole cohort of younger
Chinese that are heavier, have greater rates of obesity as well
as diabetes, and in the future this is going to go way up.”

Chinese aged 10 to 30 are about 6-7 kilograms (15 pounds)
heavier than that age group 20 years ago, mainly due to
inactivity, and diets that comprise more sugary drinks, alcohol,
refined rice, and less fiber, Popkin said. This puts them at
higher risk of developing diabetes, he said.

Half of China’s adults, or 493.4 million people, have
higher-than-normal blood-glucose levels, which put them in a
pre-diabetic state that triples their risk of full-blown
diabetes, said Guang Ning, lead author of last week’s study and
director of the National Health and Family Planning Commission’s
laboratory for endocrine and metabolic diseases.

Cheaper Treatments

“China is trying hard to control the cost of treating
diabetes as much as possible,” said Ning, who is also head of
endocrinology and metabolism at the Rui-Jin Hospital in
Shanghai. “We have been able to do this by reducing the cost of
drugs and by encouraging more people to get treatment locally.”

Thirty-five percent of Chinese citizens’ health-care costs
were paid “out-of-pocket” in 2011, down from 58 percent in
2002, after the government expanded subsidies, according to a
State Council report published in December.

China’s doctors are encouraged to prescribe the generic
medicine metformin as a first-line drug for diabetics, while
patients who prefer traditional remedies are given huang lian su
tablets, containing berberine, a plant extract shown to be
effective in treating Type 2 diabetes, Ning said. Both these
options are much cheaper than imported medicines, he added.

“The major way to reduce the economic burden is to have a
good primary care system so many of these people can be treated
there, reducing the hospital expenditure,” said the University
of Hong Kong’s Lam. “There is a golden opportunity for early
treatment or early prevention to make sure people can reduce
their risk.”

To contact Bloomberg News staff for this story:
Daryl Loo in Beijing at
dloo7@bloomberg.net;
Natasha Khan in Hong Kong at
nkhan51@bloomberg.net

To contact the editor responsible for this story:
Jason Gale at
j.gale@bloomberg.net


Enlarge image
Diabetes Hospital

Diabetes Hospital

Diabetes Hospital

Wang Zhao/AFP/Getty Images

A woman waits to receive treatment as she sits in front of billboards about diabetes at a diabetes hospital in Beijing.

A woman waits to receive treatment as she sits in front of billboards about diabetes at a diabetes hospital in Beijing. Photographer: Wang Zhao/AFP/Getty Images


China's Diabetes ‘Catastrophe’ Afflicts 114 Million

Sept. 4 (Bloomberg) — The most comprehensive nationwide survey for diabetes ever conducted in China shows 11.6 percent of adults, or 114 million, has the disease. The finding, published yesterday in the Journal of the American Medical Association, adds 22 million diabetics, or the population of Australia, to a 2007 estimate and means almost one in three diabetes sufferers globally is in China. Stephen Engle reports. (Source: Bloomberg)

Feds Spending $2.2 Million to Study Lesbian Obesity | Washington …

AP

AP

BY:

September 5, 2013 11:35 am

The federal government has spent $2.2 million studying why three quarters of lesbians are obese despite sequestration-mandated budget cuts that critics warned could “delay progress in medical breakthroughs.”

The National Institutes of Health awarded an additional $682,873 to Brigham and Women’s Hospital for the study on July 17. The project had received previous grants of $778,622 in 2011, and $741,378 in 2012. Total funding has reached $2,202,873.

The project has survived budget cuts due to sequestration, which the NIH warned would “delay progress in medical breakthroughs.”

The study, being led by S. Bryn Austin, an associate epidemiologist at Brigham and Women’s Hospital, sets out to find the biological and social factors for why “three-quarters” of lesbians are obese and why gay males are not.

At the time this study was first reported, a spokesman for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which is administering the project, said its future was uncertain because of the sequester.

“The NIH is currently assessing the impact on funding due to sequestration,” said Robert Bock, press officer for the NICHD, in March. “It is not possible to say how this (or any other NIH grant) will be affected in the long term beyond the 90 percent funding levels already in place.”

The NIH said the automatic budget cuts forced the agency to cut 5 percent of its fiscal year 2013 budget, amounting to a $1.55 billion reduction in spending.

“NIH must apply the cut evenly across all programs, projects, and activities (PPAs), which are primarily NIH institutes and centers,” the agency said in June. “This means every area of medical research will be affected.”

The NIH said cuts to research are “delaying progress in medical breakthroughs,” including the development of cancer drugs and research on a universal flu vaccine.

The study on disparities between sexual orientation and obesity continues to receive funding.

“Obesity is one of the most critical public health issues affecting the U.S. today,” the grant’s “public health relevance” statement reads. “Racial and socioeconomic disparities in the determinants, distribution, and consequences of obesity are receiving increasing attention; however, one area that is only beginning to be recognized is the striking interplay of gender and sexual orientation in obesity disparities.”

“It is now well-established that women of minority sexual orientation are disproportionately affected by the obesity epidemic, with nearly three-quarters of adult lesbians overweight or obese, compared to half of heterosexual women,” the project’s abstract states. “In stark contrast, among men, heterosexual males have nearly double the risk of obesity compared to gay males.”

Though Bock declined to comment for this story, the NIH issued a general statement to the Washington Free Beacon defending the study as part of its overall mission to reduce obesity in the United States.

“NIH research addresses the full spectrum of human health across all populations of Americans,” the NIH said. “Research into unhealthy human behaviors that are estimated to be the proximal cause of more than half of the disease burden in the U.S. will continue to be an important area of research supported by NIH.”

“Only by developing effective prevention and treatment strategies for health-injuring behaviors such as smoking, excessive alcohol consumption, drug abuse, inactivity, and poor diet, can we reduce the disease burden in the U.S. and thus enhance health and lengthen life, which is the mission of the NIH,” they said.

Thus far, the study has yielded one report, published in January, which found that gay and bisexual males had a “greater desire for toned muscles than completely and mostly heterosexual males.”

Maintain, Don't Gain: A New Way To Fight Obesity | Duke Today

Durham, NC – Programs aimed at helping obese black women lose weight have not had the same success as programs for black men and white men and women.

But new research from Duke University has found that a successful alternative could be a “maintain, don’t gain” approach.

The study, which appears in the Aug. 26 issue of JAMA Internal Medicine, compared changes in weight and risk for diabetes, heart disease or stroke among 194 premenopausal black women, aged 25-44. They were recruited from Piedmont Health’s six nonprofit community health centers in a multi-county area of central North Carolina, which serves predominantly poor patients.

For the study, half of the participants — 97 women — were randomly placed in a primary care-based intervention program called Shape, while the other 97 received usual care from their physicians, generally weight-loss counseling.

The intervention program used software built by Duke researchers that personalized the intervention for each woman. Each woman received an individualized set of behavior-change goals for diet and physical activity. They tracked how well they were doing each week via automated phone calls, and had a personal health coach and a gym membership.

After 12 months, the intervention group stabilized their weight, while participants in the usual care group continued to gain weight. Sixty-two percent of intervention participants were at or below their weight at the onset of the program, compared to 45 percent of usual-care participants. After 18 months, intervention participants still maintained their weight while the usual care group continued to gain weight.

“Many people go to great lengths to lose weight when their doctor recommends it. They may try a series of diets or join a gym or undergo really complex medical regimens. The complexity of these treatments can make it difficult for many to lose a sufficient amount of weight,” said lead author Gary Bennett, an associate professor of psychology and neuroscience and global health at Duke who studies obesity prevention.

“Our approach was different. We simply asked our patients to maintain their weight,” Bennett said. “By maintaining their current weight, these patients can reduce their likelihood of experiencing health problems later on in life.”

The study, funded by a grant from the National Institute for Diabetes and Digestive and Kidney Diseases, cited other research showing that overweight and slightly obese premenopausal black women face far lower risks for many chronic diseases than do obese whites and other racial groups.

But by ages 40-59, black women have more than twice the prevalence of class 2 (moderate) obesity and three times the rate of class 3 (extreme) obesity than white women, the study said. This combination of rapid premenopausal weight gain and extreme obesity contributes to disproportionate chronic disease risk among black women, researchers said.

Preventing weight gain could reduce the odds of developing a host of health problems, such as high blood pressure, high cholesterol diabetes, cardiovascular disease, stroke and some cancers, the authors said.

A “maintain, don’t gain” approach could be particularly effective for this group for the following reasons:

— Compared to white women, black women are typically more satisfied with their weight and face fewer social pressures to lose weight, Bennett said. Consequently, they may be particularly receptive to intervention messages about maintaining their weight.

— Preventing weight gain is less intense than trying to lose it, so this approach could be achieved more easily.

“It’s true that there are some health risks for these overweight and slightly obese women,” Bennett said. “However, these health risks increase dramatically as women continue to gain weight, usually 2 to 4 pounds, year after year.  

“We could reduce these health risks if women simply maintained their current weight,” Bennett said. “Fortunately, it’s much easier to maintain weight than it is to lose it. We think this ‘maintain, don’t gain’ approach can help some women reduce their risk of obesity-related chronic disease.”                          

###

CITATION: “Behavioral Treatment for Weight Gain Prevention Among Black Women in Primary Care Practice: A Randomized Controlled Trial,” lead author Gary Bennett, Perry Foley, Erica Levine, Sandy Askew, Dori Steinberg, Bryan Batch, Duke University; Jessica Whiteley, University of Massachusetts Boston; Mary Greaney, Dana-Farber Cancer Institute; Heather Miranda, Thomas Wroth, Marni Holder, Piedmont Health Services; Karen Emmons, Dana-Farber Cancer Institute and Harvard School of Public Health; Elaine Puleo, University of Massachusetts Amherst. JAMA Internal Medicine, online Aug. 26, 2013; DOI:10.1001/jamainternmed.2013.9263./////

Go for comprehensive health plans covering diabetes

Recently, public sector insurer New India Assurance did away with the practice of charging extra premium from those suffering from diabetes and hypertension, under its revised health policy. The insurer’s move is aimed at reducing claim procedure.

Some pointed to the fact that this comes close on the heels of new guidelines that don’t allow extra loading, effective October. Sooner or later, all companies would have to comply with this. Currently, health insurers such as ICICI Lombard, Apollo Munich and Bajaj Allianz cover diabetes and hypertension as pre-existing diseases (after a waiting period). New India Assurance would have a four-year waiting period for a cover on the two diseases.

Renuka Kanvinde, head (health insurance) at Bajaj Allianz General Insurance, says the insurer covers diabetes as a pre-existing disease, without any extra loading at any stage of the disease. While ICICI Lombard covers diabetes and hypertension without loading, albeit only mild cases, Star Health has a rider for diabetes cover — it is priced taking into account diabetes-related risks to kidney, heart, eyes and brain.

Increasing cases of diabetes and related ailments have led a few insurers such as Apollo Munich and Religare Health Insurance to consider a standalone diabetes cover. There are also bank-provided group policies that cover diabetes.

How should a policyholder choose between these? While there aren’t any standalone covers yet, experts believe these would come at a price—15-25 per cent compared to health insurance plans. Antony Jacob, chief executive officer of Apollo Munich, says research suggests healthcare costs of a diabetic is 1.5-2 times the cost incurred by a non-diabetic, and the company’s premium would be in line with this finding.

Amit Bhandari, ICICI Lombard’s vice-president (health underwriting product), says though standalone plans may not cover any other ailment, these might have features such as discounts on diabetes-specific medicines or health check-ups. Before taking a decision, one should carefully weigh the extra premium loading vis-a-vis the sum of benefits.

Experts say insurers who don’t charge extra for covering diabetes may do so after a couple of claims. However, these plans would be helpful for more than one health issue. Group health plans offered by banks cover hospitalisation for any ailment related to diabetes. Typically, these policies don’t have sub-limits, premium loading or co-pay clauses.

S Prakash, executive director, Star Health Insurance, says, “Those who don’t have health coverage yet should obviously buy a comprehensive plan that covers diabetes also, if they suffer or are at risk. But those who already own a health policy can opt for a rider.” Kanvinde says disease-specific covers are required only if the comprehensive cover you have or have chosen doesn’t cover that particular disease.

Premium loading is not a short-term measure; it would increase your annual premium and should be a key determinant of your choice of insurer.

Comprehensive covers have an edge over other options, even in terms of premium. Star Health rider costs Rs 6,385 for a Rs 5-lakh-cover for 25-35 years. A comprehensive cover would cost about Rs 5,000 (26-40 years) for the same cover (Bajaj Allianz General Insurance), while a group policy could cost Rs 10,000-12,000. For group policies, premium increases only after the age of 65, and again after 80. The premium could also rise based on claims or the age bracket.