The Cultural War on Diabetes

Article excerpt

Byline: Andrew Murr

There's an epidemic underway in this country, and minority communities are being hit hard. How two Los Angeles doctors are finding new ways to help.

The teenager had the kind of story Drs. Francine Kaufman and Anne Peters hear far too often. Adrian Rivera was a chunky but active 15-year-old when he returned to California in late 2004 after two energetic years living on an uncle's ranch in Mexico. But activity turned to torpor as Rivera sat around the house in Whittier, Calif., waiting for school to start. "All I did was eat, sleep and play my PlayStation and Game Boy," recalls Adrian, now 17. In just two months, the 5-foot-9 teen's weight shot from 192 pounds to 255. Alarmed, his parents took him to the family doctor, who diagnosed type 2 diabetes.

Now a patient at Kaufman's pediatric-diabetes clinic, Rivera is another statistic in the nation's diabetes epidemic. The disease is hitting minority communities hard: nearly half of all African-American and Latino children born in 2000 are expected to become diabetic at some time in their lives, according to a projection by the Centers for Disease Control and Prevention. (The ratio for all Americans born that year is expected to be one in three.) Which is why Kaufman and Peters, both from the University of Southern California's Keck School of Medicine, are rushing to find innovative treatments for current patients -- and effective prevention regimens to keep at-risk populations from becoming diabetic. "We are at the vortex of the obesity and type 2 diabetes explosion," says Kaufman, a past president of the American Diabetes Association.

Working separately and together, Kaufman and Peters are "definitely on the front lines" of the diabetes fight, says Ann Albright, CDC's director of the Division of Diabetes Translation, which "translates" clinical research into public-health practices. Peters, who treats adults, believes she can deliver quality diabetes care in poor minority communities equaling what she gives paying patients at a USC clinic she directs in Beverly Hills. So, in an effort "to prove you can improve the health of the poorest of the poor," two or three days a week she leads a team that cares for 2,000 working-class immigrant diabetics at an L.A. County-run clinic in predominantly Latino East Los Angeles. Meanwhile, Kaufman, who treats kids, heads the Center for Diabetes, Endocrinology & Metabolism at Childrens Hospital Los Angeles.

Weight loss, increased exercise and better diets are known to prevent prediabetes -- a condition in which blood-sugar levels are only slightly elevated -- from becoming the full-blown disease. In 2004, Peters and Kaufman teamed up to study diabetes and tailor solutions in a pair of Los Angeles ZIP codes where the disease ran high, one in Latino East L.A. and another in South L.A. with a mix of blacks and Latinos. They identified lots of problems, including few grocery stores with fresh vegetables and an oversupply of fast-food joints. "It's one thing to say 'eat healthy,' but it's hard when you can't find healthy food," says Peters.

The docs discovered other cultural barriers to attacking obesity. Fast food was a status symbol, especially among new immigrants. Ironically, fear of food shortages may lead some to eat too much. About one third of the American-born blacks and Latinos surveyed said they'd gone hungry at least once in the previous year; half the immigrants said they had. "If I thought I was going to run out of food, would I go on a diet?" asks Peters. "Are you kidding?" Even a healthy disregard for the American obsession with thinness worked against the families. About 71 percent of the moms thought their kids were of normal weight -- but in fact nearly half to two thirds of them were overweight or obese. Kaufman sees the same cultural anomaly when families bring toddlers for checkups. "The baby comes in and he's a butterball, but if you ask Grandma, he's not eating enough," she notes. …