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Step Up
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Change Your Health & Change Your Future
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By Elinor Nauen
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Diabetes Focus Third Quarter 2008
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The one-two punch of obesity and diabetes can cause staggering health problems. And no group suffers more from this double trouble than the Hispanic community.
In the U.S., Hispanics (people of Cuban, Mexican, Puerto Rican, South or Central American and other Spanish cultures and origins, regardless of race) suffer from obesity and diabetes at a far higher rate than does the U.S. population as a whole.
Why has this health crisis developed? Experts suggest it’s the result of a combination of factors that include genetics, the environment and various cultural and circumstantial influences.
Genetics. Genetics plays a role in diabetes as well as obesity. “Latinos have a genetic tendency to accumulate abdominal fat. And obesity is more common among Latinos than whites, especially the more dangerous central or abdominal obesity,” says A. Enrique Caballero, M.D., director of the Latino Diabetes Initiative (LDI) at Joslin Diabetes Center in Boston. “We think that may contribute to their currently high rates of diabetes.” At least 80 percent of people with type 2 diabetes are overweight or obese, according to the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK).
Furthermore, children of obese or overweight parents are at greater risk of becoming obese or overweight themselves. And according to a University of Michigan study, obese kids are more than twice as likely as children of normal weight to have diabetes.
It’s less clear which genes are implicated in diabetes. More than 200 have been identified as playing a role. “Complex diseases like diabetes are not single-gene diseases, and we aren’t going to find just one gene that causes them. It’s not how they work,” says Joanne E. Curran, Ph.D., assistant scientist in the department of genetics at the Southwest Foundation for Biomedical Research in San Antonio.
Lack of exercise. Recent data indicate that 42 percent of Hispanics report no leisure-time physical activity at all. Many others get less than the recommended amount of activity in a day or week. One reason for this problem is that nearly half of all Hispanics live in the inner city, where the opportunities to be physically active are often scarce or nonexistent.
Unhealthy eating. Maintaining an appropriate weight requires a person to choose to eat whole grains and fresh fruits and vegetables. Many inner-city stores don’t offer those choices. Latinos who are fairly recent arrivals in the U.S. may find that the transition takes a toll on their health.
Lack of insurance. The Centers for Disease Control and Prevention reports that in 2006 more than a third of Hispanics under the age of 65 had no health insurance, as compared with 17 percent of the total population. And among Hispanics, Mexican-Americans were least likely to be insured.
The result of this confluence of factors is dramatic. If you are Hispanic, the likelihood that you or someone in your family will be diagnosed with diabetes is increasing every year. From 1997 to 2005, the risk to Hispanic women increased 16 percent, and the risk to Hispanic men jumped 21 percent. Hispanic children born in 2000 or later have an almost 50-50 chance of developing the disease.
You can reduce your obesity- and diabetes-associated health risks even if you are genetically predisposed to develop the disease, are overweight or have been diagnosed with prediabetes (a condition in which blood sugar is higher than normal but not high enough to warrant a diagnosis of diabetes). But according to Dr. Caballero, Latinos have the special burden of battling a cultural perspective that often sees heaviness as a sign of good health. (“Which it’s not!” he notes.)
Nonetheless, he believes the Hispanic community can find effective ways to improve its health, even within its own traditions and norms. “Everyone needs a different motivator. In the Latino culture, family is a very powerful one,” says Dr. Caballero. “We invite all family members to make healthy changes for their children and grandchildren, if not so much for themselves.”
The two most important steps that people can take are to improve their nutrition and to increase their level of physical activity.
Eat well. One important point to keep in mind: You don’t have to forsake your native cuisine in order to upgrade your diet.
“Some health-care providers may tell people to eat cereal in the morning, fish and vegetables for lunch,” says Dr. Caballero. “But that doesn’t fit the lifestyle of some people from South America. They may say, ‘We prefer to eat our traditional dishes that sometimes may be high in carbohydrates and saturated fats.’
“That’s why it’s better to try to improve on portion sizes [by making them smaller] and to learn how to cook those favorite meals in a healthier way.” (For help with healthy Latino cooking, see our recipes from Chef LaLa on page 8.)
Move. To encourage people to be physically active, the National Diabetes Education Program (NDEP) has launched the “Small Steps. Big Rewards. Prevent Type 2 Diabetes” campaign. Based on information and data gathered through a large and highly successful clinical trial called the Diabetes Prevention Program (DPP), the campaign encourages people with prediabetes to make slight changes that could delay and po ssibly prevent onset of the disease. The DPP found that people with prediabetes who lost 5 to 7 percent of their body weight (for someone who weighs 200 pounds, that’s 10 to 14 pounds) and got 150 minutes of physical activity a week (that’s 30 minutes on five days) cut their risk of developing type 2 diabetes by 58 percent.
“Regardless of genetic background, the environment can make a big difference, and the intervention seemed to work,” points out Judith Fradkin, M.D., director of the Diabetes, Endocrinology and Metabolic Diseases Division of the NIDDK.
So what’s the bottom line? Starting today, you can begin to take small and essential steps that will lead to better health. If you need help, talk with your doctor or health-care provider. Consider consulting with a diabetes educator, a nutritionist and/or an exercise physiologist. And always enlist the support and help of family and friends. But whatever you do, don’t put off until tomorrow what you can do right now. Take your first small step today, and you will be on your way to seeing big rewards.
“Diabetes is a serious disease that deserves attention,” says Dr. Caballero. “It’s a silent disease that can kill. Cancer and HIV are scary, but the reality is that the mortality of diabetes is a lot higher than cancer and HIV combined. While we can’t cure diabetes, we can control it and reduce the amount and severity of complications, which means people can achieve a better quality of life and live longer.”
Women’s Extra Risk for Heart Disease
by Stacey Colino
When it comes to matters of the heart, diabetes wreaks damage on a
microvascular level, harming the kidneys, eyes and nerves, and on a
macrovascular level, taking a toll on the heart. Having diabetes
increases a person’s risk for heart disease or stroke two- to
four-fold. Hispanic women have a risk for heart disease that is
comparable to the risk level of non-Hispanic Caucasian women who are a
decade older. This disparity may be linked to Hispanics’ lower levels
of physical activity and higher rate of metabolic syndrome, a cluster
of risk factors associated with type 2 and heart disease. These risk
factors include high fasting blood sugar levels, low HDL (good)
cholesterol, high triglycerides, a large waist circumference (35 inches
or more for women) and high blood pressure.
“In the Latino population, there’s more obesity, worse lipid profiles
and more insulin resistance,” explains Dr. Caballero. “This is due
partly to genetic factors but partly to activity and nutrition
patterns. In Latinos, the beta cells, which produce insulin, may get
tired more quickly than in other people, which increases the risk of
type 2 diabetes. And once diagnosed, Latinos tend to have more
complications.”
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