Bearing the burden: why are communities of color facing obesity and diabetes at epidemic levels? (Report).
Instead of calling out for help, she lit up a cigarette and waited it our in a women's restroom. The heart attack didn't kill her, but lymphoma did, years later. Then Gauthier's father died from diabetes two years ago, largely from factors related to his diet and lifestyle.
Gauthier, one of 30 nurses nationally with advanced training in assessing heart disease risk in women, struggles with her own weight and high blood pressure.
"I don't want to have a heart attack at 42, like my mom did," says Gauthier, the care coordinator for the Tulane Xavier National Center of Excellence in Women's Health in New Orleans. "Some weeks I don't do all the things I need to do [to minimize my health risks], but I never stop trying."
From Gauthier's standpoint, it is imperative to keep trying to eat well and to get enough exercise, because the alternative is to join the ranks of a larger statistical trend of obesity--and related, chronic health conditions--now commonplace across the U.S., most acutely in communities of color.
While 17 percent of whites fir the criteria for obesity, 27 percent of African Americans and 21 percent of Latinos are considered obese, and therefore at increased risk for major health problems, including diabetes, asthma, hypertension and kidney and heart disease. (Altogether, nearly 300,000 deaths per year are now associated with obesity.)
People of color living at lower economic levels are even more likely to be obese: nearly 34 percent of African Americans and 25 percent of Latinos earning less than $10,000 are obese, compared with 19 percent of whites.
The problem of obesity in communities of color is not limited to Latinos and African Americans, however. Although Native Americans, Asian Americans and Pacific Islanders are not tracked as closely in obesity issues, it's known that roughly 60 percent of urban Indians are overweight, and that Samoans and Native Hawaiians frequently struggle with obesity and related health complications, particularly after moving to the mainland.
"The situation facing Indians here is very similar to what natives are dealing with in other areas," says Billy Rogers, director of the Native Wellness Institute in Norman, Oklahoma. "You make people feel bad about their culture, you take away their family systems, their lifestyle, and there are going to be very dramatic changes in people's diets and bodies.
"What I see are people who don't know who they are anymore, to a great extent, adds Rogers. "They've embraced the values of the dominant culture, which is a fast food culture. It's an 'I want it now and I don't have much patience' culture."
Over 60 percent of all Americans are now overweight, and experts agree that fast food, television, office jobs, lack of fresh fruits and vegetables in school lunches, and genetic factors have all conspired to make Americans of all ages fatter. But for people of color and poor people, the issues are even more complex and far-reaching.
According to a study published last year in the American Journal of Preventive Medicine, there are four times more supermarkets in predominantly white neighborhoods, compared to predominantly African American neighborhoods.
The University of North Carolina School of Medicine-funded study set out to study the prevalence of supermarkets, convenience stores, restaurants, and bars in a variety of neighborhoods in Mississippi, North Carolina, Maryland, and Minnesota. The study proved what many community activists and health care providers had known for years: poor, black neighborhoods have an excess of bars and convenience stores, and not enough places from which to buy healthier produce and foodstuffs.
The study also demonstrated that relatively few households in poor, African American neighborhoods had access to private transportation, making it even harder to obtain healthy food.
"There are fewer options for many of my patients in their neighborhoods," agrees Dr. Jeanette Newton Keith, assistant professor of clinical medicine and an attending physician at the University of Chicago Hospitals. "This is by far one of the most difficult challenges to overcome.
Dr. Keith, an African American physician and specialist in both gastroenterology and clinical nutrition, tries to encourage her patients to rake public transportation to local farmers' markets, or to grow simple summer gardens for vegetables like tomatoes and cucumbers.
In talking about the real health risks facing women of color, Gauthier is careful to frame the topics of nutrition and exercise in ways that are both situationally and culturally relevant to the women who attend her Wellness Wednesdays sessions in New Orleans, which are tailored to address participants' pressing health questions and concerns.
"When we talk about women of color, we have to realize we're often talking about women with children, women with low incomes, and women who are in situations where the first thing on their mind is survival. It's not about 'how healthy I am,' but about 'how my child is going to be fed today."
Nutritional and calorie-cutting advice should be no different in this regard, notes Gauthier.
"We have communities, like the African American and Hispanic communities, where we celebrate with food," she explains. "When you tell us that we need to stop eating all these [foods] that we've grown up with, that are cultural in nature, that have made us feel good in the past ... and then you tell us that these foods are killing us, you've got to think about the message we're receiving."
The message is far better received, Gauthier says, if it makes room for the role of food in celebrations, family reunions, and Sunday dinners, but advises people to avoid eating fat-laden dishes on a daily basis.
What's more, says Jose Camaro, health educator at La Clinica de la Raza in Oakland, California, telling people not to eat certain foods from their culture is an approach that usually backfires.
To make matters worse, says Dr. Keith, television acts to limit people's physical activity, and to inundate adults and children alike with images of junk food and fast food.
In a study presented last year by the University of Chicago Children's Hospital, researchers revealed that black prime time television actually contains 60 percent more food and beverage commercials, and more images of soda and candy than are shown on general prime time television. Fully 36 percent of commercials during black prime time television, for instance, advertised desserts and sweets, while another 31 percent advertised fast food.
Most surprising was the finding that 27 percent of actors on black prime time were overweight, as opposed to only 2 percent on general prime time. According to the researchers, the prevalence of overweight characters on black prime time may be sending the detrimental message that obesity is acceptable, despite the attendant health risks.
But on another level, the presence of heavier actors on television may not, in and of itself, be a bad thing. In many communities of color, what constitutes a desirable or beautiful appearance is not always dictated by the narrow aesthetics of the dominant society.
In the African American community, celebrities including Oprah, Missy Elliott, Queen Latifah, India Arie, and Star Jones have played a part in helping many women of color to feel good about the way they look and to feel proud of their own generous curves.
The realization that health can be attained without shrinking one's natural body size is one of the most important messages that Gauthier tries to get across to her patients.
"What we need to focus on more than an unrealistic view of what a woman's body should look like is that women are dying at alarming rates from obesity-related illnesses."
Top among that list of illnesses is diabetes, which has struck communities of color particularly heavily.
"In our population, we're definitely seeing an. increase in obese and diabetic patients," explains Camaro of La Clinica de Ia Raza. "Where we used to see people with Type 2 (non-insulin-dependent) diabetes after 40, we now have diabetics as young as 18 years of age."
Studies have confirmed that immigrants often fare worse in terms of their diet and weight after they leave their native countries. A large-scale 1998 University of North Carolina at Chapel Hill study demonstrated that adolescent obesity increases significantly among second and third-generation immigrants to the U.S.
In the study, all Asian immigrant groups except Chinese and Filipinos doubled their proportion of obese children during the transition from first to second generation residency. Latinos showed similar increases in obesity between first and second generations.
Other studies have shown that the prevalence of diabetes in Chinese Americans is reported to be five to seven times higher than the rates in China.
Perhaps no single ethnic group has been more devastated by obesity and diabetes than Native Americans, for whom the death rate from diabetes is nearly 250 percent greater than the national average.
On South Dakota reservations, including Rosebud and Pine Ridge, it's estimated that 50 to 60 percent of adults over 45 have diabetes. Children as young as 13 and 14 are being diagnosed with Type 2 diabetes, formerly called "adult-onset diabetes."
The nation's most extensively researched Native American tribe, the Pima Indians of Arizona, have even lent their bodies to science for the past three decades to help researchers prove the causal link between obesity and diabetes.
Among Pimas over the age of 55, 80 percent have diabetes. Amputations, blindness, and dialysis are now a regular part of Pima reservation life.
The extent of the research and the lack of direct health benefit to Pimas themselves have been criticized in recent years by community leaders, who point to the ever-growing rates of obesity and diabetes among Pima Indians as evidence of the fact that the research has helped scientists, but nor the people being studied.
Body of Tradition
But one thing of use to health educators and physicians working with Native Americans has been the recognition that genetic factors have played a strong part in the prevalence of obesity and diabetes.
The so-called "thrifty gene" theory is based on the fact that, for thousands of years, many Indian tribes practiced an active hunting and gathering lifestyle, experiencing alternating periods of feast and famine. Their bodies evolved to allow them to store fat during "feast" times, so as to prevent starvation during leaner times.
Anthropological studies have suggested that 17 percent of 19th century Indians' caloric intake was from fat. Today, that figure is closer to 38 percent, as root vegetables, fish, buffalo, and berries have given way to soda pop, processed meats, dairy products, and a starch-heavy diet.
The U.S. government bears some direct responsibility for that dietary shift, notes Rogers of the Native Wellness Institute, in the form of the commodities provided to Indians on the reservation.
"I can remember being seven or eight and going with my grandparents to the Department of Agriculture in town and picking up our flour, cheese, and bucket of lard," says Rogers.
Unlike many of his young Indian peers, Rogers' Kiowa grandparents believed in serving more traditional foods, including berries, deer, and fish. His grandparents also inculcated in Rogers the importance of a respectful relationship to the creatures and environment that helped to sustain him.
But in the present-day, Rogers sees that physical wellness is suffering as a direct result of cultural, regional, and spiritual displacement among many Indian people.
"A lot of the reasons why people overeat or are obese is related to something deeper inside," says Rogers firmly. "Much of it is related to how much power we see ourselves as having. And part of where we are as a physical nation is directly related to our own acculturation, stress, and the problems we've had adapting to a society that we're not very comfortable with. So many of the problems in terms of obesity are related to pain and historical suffering."
"Traditionally, we've taken great pride in our bodies," Rogers adds. "Our bodies were viewed as [the vessel] carrying our spirit. And we have to treat our bodies with respect."
Silja J. A. Talvi is a freelance journalist who has written for In These Times and the Christian Science Monitor, among other publications.
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|Author:||Talvi, Silja J.A.|
|Date:||Sep 22, 2002|
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