Californians gain weight, and diabetes rate soars
35,000 obesity-related deaths predicted for 1999
Californians have enjoyed a reputation for being conscious of their health and appearance. But new statistics released by the state’s Department of Health Services show those images may be changing.
In fact, the number of Californians who are obese leaped by 50% between 1984 and 1997, and the rate of diabetes increased by 25% in the same time period. The figures were even worse among Hispanic and low-income women, with the obesity rate increasing by 75% and 80% respectively.
"Like we see in the rest of the country, Califor-nians are becoming more reliant on fast foods, less conscious of healthy eating habits, and more sedentary," says Susan Foerster, MPH, RD, a researcher with the California Department of Health Services in Sacramento. "It’s not surprising we are seeing more diabetes." Along with those startling figures goes the Department of Health Services’ gloomy prediction for 1999: Obesity and obesity-related chronic diseases will claim 35,000 lives in California alone this year.
Since the connection between obesity and diabetes is well-established, Foerster says, the study’s results present a challenge to health care professionals to reverse the trend through education.
She says the study, which surveyed more than 5,000 California adults in an eight-year period, is the first to directly link increasing obesity rates to a variety of chronic diseases, including diabetes, heart disease, and cancer.
Department of Health Services researchers say the survey shows an "alarming" downward trend in health habits in spite of gains in health knowledge. "We live in the richest agricultural state in the world, yet we’re passing up healthy foods like fruits, vegetables, and low-fat milk for foods high in fat and added sugar," reported state health officer James W. Stratton, MD, MPH in a written statement issued in September. "These eating habits will cause more illness, premature deaths, and increased health care costs."
To put the health department’s statistics in perspective, Foerster says poor diet and lack of physical activity combine to be the No. 2 cause of preventable death in the state, preceded only by tobacco use. "Since tobacco use is declining, we expect this to become the No. 1 cause of preventable death very soon," she says.
Only 5% of the subjects were eating enough dietary fiber for good health, 30% reported they ate the recommended five servings of fruits and vegetables a day, while 20% reported no leisure time physical activity in the past month. Half the respondents reported they ate at fast food restaurants at least once a month, up from 33% in 1989.
"It’s alarming — the sheer numbers of obese adults coming in with diabetes and varying degrees of glucose intolerance," says Gary Wong, MD, MPH, regional physician coordinator for preventive care services at Kaiser-Permanente in Fontana, CA.
The number of patients in Kaiser’s diabetic registry has increased each year of the five years it has been in existence, he says, and verifies the statewide escalation in the prevalence of diabetes.
Wong says U.S. per capita sugar consumption alone is telling: Each of us now eats 150 pounds of sugar each year, compared to 120 pounds just five years ago. We’re more sedentary than we’ve ever been, he says. There are fewer restaurant selections of lower fat foods and more 32 oz. soft drinks and super-size portions of burgers and fries then ever. And the growing rate of consumption of fast food is taking a toll on health. California may be following the national trend, which according to the Oct. 27 Journal of the American Medical Association, shows obesity rates climbing across the country.
Sophisticated fast-food marketing presents a big problem, Wong and Foerster agree, since it is almost impossible for state agencies, nonprofit organizations, and even the federal government to counter multimillion dollar television campaigns singing the praises of high-fat foods.
Diet and exercise advice must go hand in hand, says Wong. Yet, he’s somewhat pessimistic about the chances for those who are already obese. "We don’t really have any good long-term treatment outcomes once obesity has developed, so we really have to focus now on obesity prevention. We need to become better at stratifying our population to see who is at greater risk of developing obesity and diabetes and act aggressively to prevent either disease from developing. We can’t wait to act after it happens."
Patients at greatest risk should be targeted for intensive prevention campaigns, he says. Risks include having a family history of diabetes, being a member of an ethnic minority, and showing early signs of diabetes such as glucose intolerance.
Wong also encourages clinicians to educate parents to be more vigilant about food and exercise choices at home and at school.
Foerster says the study also showed the general public has some awareness of diet and exercise recommendations, but being aware of the guidelines and getting with the program are two different things. The crisis of obesity calls for micro- and macro-approaches to the problem, from employers to taxpayers to every agency involved with health care, she says.
A state of concern
Since funding for major advertising campaigns is not a realistic expectation, Foerster says, Califor-nia is opting for a micro approach that reaches the grass roots at a comparatively low cost. "It’s a matter of seeing how serious it is. I don’t think it’s going to cost that much money to turn this thing around."
The California Department of Health Services is using its resources to encourage its residents to get their five servings of fruits and vegetables each day and 30 minutes of exercise at least three times a week. Targeting the high-risk, low-income segment of the population, the state has created a multifaceted approach, which includes these tactics:
• transit ads;
• funding for communities to come up with their own programs, contests, and competitions;
• a school program with teen advocates who chose a project for the year and accomplish it before the year’s end;
• funding programs in African-American churches that include walking groups and victory gardens;
• a program encouraging employers to provide exercise and healthy eating options for their employees, as well as bike lockers, showers, and even walking meetings when practical;
• family programs that get parents and kids together for exercise programs and some that allow moms time away from their kids so they can exercise or attend a cooking class.
"We don’t expect instant results, but we think we can bring about a culture change for the better," Foerster says.
[Contact Susan Foerster at (916) 322-1520 and Gary Wong at (909) 427-5818.]
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