Saturday, November 11, 2006

Diabetes a serious problem for American Indians

This article tells us that the numbers of younger Indians with diabetes are increasing.

From 1994 to 2004, the rate of diagnosed diabetes among American Indians and Alaska Natives younger than 35 years of age increased from 8.5 to 17.1 cases per 1000 population, according to findings released Thursday.

What explains this jump?

"This increase in diagnosed diabetes might be the result of increased incidence of diabetes, increased screening for diabetes, or a combination of both," the report indicates.

In other words, they don't know if Indians have always had that much diabetes or if it's increasing. Either way, it's too high a rate and it needs to be addressed.

You hear over and over that diabetes is a common problem in Native people, but it's still surprising to see those kinds of numbers. We all know that Indians struggle with a lot of health problems that mainstream America doesn't. The question is why, and how do we fix it?

The findings underscore the importance of a proper diet and physical activity for reducing diabetes risk.

That's true for everybody, not just Indians. The problem is that diabetes is so common among Indians, as is being overweight and obese. These are the root causes of it. The factors behind the root causes are both behavioral and genetic. Info from

Obesity is a major risk factor for type 2 diabetes among all races and ethnic groups. Increasing rates of obesity have been measured in many American Indian and Alaska Native communities. In Pima Indians, 95 percent of those with diabetes are overweight.

The study of obesity and energy metabolism in Pima Indians has not identified exact causes but has revealed that Pima Indian families share the trait of low metabolic rate. This trait is considered predictive of weight gain and development of type 2 diabetes. A "thrifty gene" is also thought to cause a genetic predisposition to obesity, although this gene has not been identified. The thrifty gene theory, first proposed in 1962, suggests that populations of indigenous people who experienced alternating periods of feast and famine gradually adapted by developing a way to store fat more efficiently during periods of plenty to better survive famines.

The degree to which obesity is a risk factor for diabetes depends greatly on the location of the excess weight. Central or upper-body obesity is a stronger risk factor for type 2 diabetes than excess weight carried below the waist. In young Pima Indians, waist-to-hip ratio, a measure of central obesity, was more strongly associated with diabetes than body mass index, a measure of overall obesity.

Diet and Physical Inactivity
Both diet and physical activity have changed for many members of American Indian and Alaska Native groups over the past several decades. Diets are higher in fat and calories than traditional diets; physical activity has decreased. Changes in diet and physical activity are associated with the increased prevalence of type 2 diabetes. For example, Pima Indians living in Mexico who consumed a more traditional diet (less animal fat and more complex carbohydrates) had a lower prevalence of type 2 diabetes than Pima Indians living in Arizona. Pima Indians in Mexico also expended more calories through activity.

There may also be a genetic bias among Indians towards being diabetic:

Genetic background is a determining factor in the prevalence of type 2 diabetes. In both the Choctaw Indians and the Pima Indians, the more full-blooded individuals were found to have the highest prevalence of type 2 diabetes, as compared with those of more mixed heritage. In Pima Indians, diabetes rates were found to be highest in children whose parents developed diabetes at an early age.

Although the specific genes responsible for the inheritance of type 2 diabetes have not been located, NIDDK scientists studying the Pima Indians have identified a gene called FABP2 that may play a role in insulin resistance. More recent studies have shown that a variant in the PPPIR3 gene that is more common in Pimas than Caucasians is associated with type 2 diabetes and insulin resistance.

The American lifestyle is proven to be bad for Euro-Americans, leading to increasing rates of obesity for them. For American Indians however, it's even worse because their bodies are even less tolerant of the sedentary, fat-eating lifestyle. Americans, Indian and otherwise, really need to look at living healthier lifestyles.


After having a conversation with fan boy, I thought there were some relevant points that should be posted on here. In case you're wondering why we were talking about diabetes, it should be noted that both of us have family members with Type II diabetes.

Fan boy brought up the fact (and it is a fact) that eating cheap food which contributes to obesity which contributes to diabetes, is in fact more expensive factored over the long term. The medical complications arising from obesity are numerous, but to name a few you have heart problems, fertility problems, joint problems, and even sleep problems, (apnea) which can lead to car accidents when the driver falls asleep at the wheel. Diabetes is just one possible complication of obesity, but it should be readily apparent that any of the complications it brings are severe and potentially deadly, as well as costly. If you take those expenses (like buying a Rebel scooter to haul your fat ass around, buying insulin, time off work, etc, etc.) and factor them into the twenty years of eating bad food before you had problems, you find that it would be a savings to double your food expenses just to eat less fatty meats, less processed frozen foods, and eat fresh vegetables.

The reason people don't do this is because the lure of spending only $50 on groceries instead of $100 is strong, and because most people are used to being healthy and only occasionally getting sick, they tend only to think of illness as an impermanent condition.

Even so, I'm not going to start with the "personal responsibility vs. environment" argument. I don't think it's time to blame anybody. Hindsight is 20/20, as the saying goes, and the vast majority of us are guilty of not planning for the future. If you're going to blame someone for not being prescient on health matters, I'll blame you for not making sure you're out of debt and gainfully employed before having kids, or not saving money for college, etc, etc. Everyone is guilty of short-sightedness. This is no different for health matters. While I do expect people to take an active role in preparing for their own futures, I admit that it's difficult to get people to focus on something in the future when they have no knowledge of that future. Without having already lived a life, how can you know that your body falls apart as you get older? That's not what an 18-year old experiences. Most teenagers and people in their 20s have been perfectly healthy their whole lives, regardless of what they did or ate. They just don't understand that that doesn't carry on. So yes, they are accountable for their own futures, but no, you can't expect them to understand what that means.

Besides which, the urgency of the moment always trumps long-term possibilities. Parents are concerned with feeding their children and paying the bills and possibly having some leisure. They skimp where they can, so they buy the 25c packages of hot dogs instead of the 99c turkey dogs. Those hot dogs may have 90 calories per, whereas the turkey dog has maybe 30. It's little things like that that make the difference. It's just that people don't see the tremendous negative effect that can have on their health until later.

Add to that that poor families have less access to health care, and you get a self-reinforcing cycle of poor health that leads to poor income. I already talked about this in a previous post.

To bring this back to the topic of American Indians, the poverty rate of Indians is at least as high as that of other minorities in general. On the reservations however, healthcare is often a very low priority for the community in general. While the reservations do vary quite a bit in prosperity, they typically range in the poorer end, and some are truly horrendous:

Unemployment on the Reservation hovers around 85% and 97% live below the Federal poverty level. Average annual family income is $3,800 as of 1999[1]. Adolescent suicide is 4 times the National average. Many of the families have no electricity, telephone, running water, or sewer. Many families use wood stoves to heat their homes. The population on Pine Ridge has among the shortest life expectancies of any group in the Western Hemisphere: approximately 47 years for males and in the low 50s for females. The infant mortality rate is five times the United States national average.

One final point: no people in the history of the world has ever had to deal with the problem of too much good food. Humans have no adaptational strategy for that. We eat because our bodies tell us we need to. Certain foods taste good because they're high in fat or sugar, stuff our bodies absolutely love because in lean times those are priceless treasures for your survival. This is just human nature, and you can't blame us for not being able to overcome it. Humans fix problems like this through social strategies. That's how we fix everything. Traditionally, human populations have kept their numbers within manageable levels by social strategies such as abstinence, abortion (yes, Christians, it isn't a new practice of the sinful world), infanticide, and war. In societies around the world today, people don't expect everyone to solve all their problems on their own; there are pre-existing social methods for it. But this problem is a new one that we haven't had time to adapt to.

To sum it all up, again, I don't want to say that personal responsibility isn't important in taking care of an individual's health. Of course they need to not smoke, drink, eat fast food all the time, etc. But you can't blame them for not being able to fix all the problems they inherited from their ancestors. This is a problem, and instead of blaming people we need to come up with strategies to fix it.

1 comment:

Xanthippas said...

Great points on the update.

I'm sure a conservative visiting our blog would go "well of course you think society ought to do something about people eating bad; your liberals and think more government is the answer to everything." To that I say,

Seriously though...a relentless parade of diet fads does not seem to be working in curbing obesity. Again, the problem is that the worst food is also the cheapest, therefore the poor among us are the most likely to eat it, and unfortunately for the rest of us, the poor are the least likely to be able to afford their own medical care. So, how does it not make sense to try to prevent health care expenses that the rest of us will pay via our state and federal taxes as best we can? It's not at all possible to remake society so that people only eat healthy food; people, being what they are, will eat what they want when they want to, even if they know better. But as government provides incentives to corporations, so too can it provide incentives to it's citizens. We can discourage them from eating bad food by making it more expensive, or a little harder to get, or by public service announcements that make people aware of how bad the food is. We can encourage them to eat better food by making better food cheaper, easier to get, and by making people aware of the positive health consequences. Nobody here or anywhere else is mandating that government shut down McDonalds and build a Whole Foods on every street corner, but there's much we can do that would not be that expensive now that may save us billions later in health care expenses, and quite simply, in lost lives. Why not do it?