“People overestimate their height, women underestimate their weight – and everybody overestimates how much they exercise,” quipped Dr. Griffin P. Rodgers as he presented the annual Frank Bryant Jr. M.D. Memorial Lecture in Medical Ethics, held Tuesday night at University of Texas Health Science Center at San Antonio. Rodgers’ joke was one of the only moments of levity in a presentation otherwise devoted to a particularly deadly disease here in South Texas: diabetes and its connection to obesity.
Rodgers was in town to deliver his talk on “Science: A Tool for Justice,” from the National Institutes of Health (NIH) in Washington, D.C. where he heads the National Institute of Diabetes and Digestive and Kidney Diseases. The title of his talk was a way of drawing attention to how the burden of disease “can fall unequally upon people of color,” Rodgers said. While a lecture on diabetes and obesity might seem like a unique way to celebrate Black History Month, it’s less so when you look at “science and medicine as tools for justice” in the case of health disparities among communities as Dr. Rodgers does.
Click here to watch his presentation via NOWCastSA.
Diabetes, for example, is an increasingly common disease of metabolism that affects the body’s ability to produce insulin and regulate blood glucose levels. While Type II diabetes, the non-inheritable kind, is on the rise nationally, it’s also true that it affects people of color in greater proportions, including African Americans, Hispanics, Native Americans and Pacific Islanders. All told, diabetes affects almost 10% of Texans; with another 12% estimated as undiagnosed.
Blacks and Hispanics are both 1.5 times more likely to be diagnosed with the disease, and 1.5 times to twice as likely to die from it, respectively. Blacks are three times as likely as whites to end up on dialysis, a consequence of end-stage kidney disease, to which diabetes is linked. Surprisingly, although African Americans represent only 13% of the population, they make up 1/3 of those who are on dialysis or are waiting for a kidney transplant, Rodgers said.
Here in the Hispanic-majority of San Antonio, figures for diabetes are “double the national average,” according to the local chapter of the American Diabetes Association. All told, diabetes is the sixth leading cause of death in Texas, and the fourth leading cause of death in Bexar County, according to statistics compiled by the Texas Diabetes Institute, which Dr. Rodgers visited on Wednesday.
Nationally, diabetes is on the rise. The prevalence of adults 18 and older with diagnosed diabetes increased 157% from 1980 through 2011, according to the Centers for Disease Control and Prevention (CDC), in a manner not reflecting changes in the age structure of the population. In fact, by the year 2050, 50 million Americans are predicted to have diabetes, Rodgers said, calling the disease “chronic, common, consequential and costly.”
National healthcare costs are significant: Annual costs for Type II diabetes run to $245 billion; obesity, $147 billion; and chronic kidney disease, $29 billion, according to Rodgers.
The only truly good news is that there is some good news, at least for those who have not yet developed the disease. “We’re learning that prevention is better than treatment,” said Rodgers in an article published by the Robert Wood Johnson Foundation, where Rodgers had served as a fellow, and he expounded on that Tuesday night. Modifying diet and exercise — as little as 30 minutes of walking, five times a week — “is effective in all age groups, and all ethnic and racial groups” for people who are at high risk for developing diabetes.
While experts initially doubted that lifestyle interventions could provide much benefit, “we proved the critics wrong,” said Rodgers. Such techniques have been written up in the New England Journal of Medicine. At UTHSCSA Tuesday, Rodgers described how the NIH has gone on to partner with the YWCA to help involve more community members in programs that can help to stave off the disease.
Obesity is often the beginning of the slippery slope of health problems, and more than a third of Hispanic adults in Texas self-report as being obese, according to statistics provided by the CDC. In fact, Texas is one of the six heaviest states in the country for Hispanics, according to the same material.
Excess sugar consumption has been implicated in obesity, which in turn can lead to diabetes and kidney disease, and a few communities nationally have taken steps to try to restrict consumer access to sugary drinks. San Antonio was one of them, but the initiative has stalled out, though it remains a priority of the Metropolitan Health Department, as described in previous articles in the Rivard Report.
Locally, Metro Health and the YMCA of Greater San Antonio have partnered to provide programs for those at risk for pre-diabetes. For more information, go to www.diabeteshelpsa.com.
During the Q&A session following the lecture, Andrea Medina, a “promotora” or community health worker affiliated with the Robert B. Green Clinic, part of the University Health System, asked Dr. Rodgers about the connection between diabetes and depression, particularly as it affects her patients whose mental health issues impede managing their diabetes.
“It’s very challenging,” she said. “We don’t have many resources (available) here to help them control their diabetes.”
“Studies show that depression and diabetes may be linked,” according to NIH literature, “but scientists do not yet know whether depression increases the risk of diabetes, or diabetes increases the risk of depression. Current research suggests that both cases are possible.” Something as simple as staying on an insulin regimen for diabetes can be complicated when mental health issues are involved, and Dr. Rodgers affirmed that more attention needs to be paid to the overlap between mental and physical health, with an increasing need to destigmatize mental health issues.
The Frank Bryant Jr. M.D. Memorial Lecture in Medical Ethics is an annual event, put on by UTHSCSA’s Center for Medical Humanities and Ethics. It honors its physician and community leader namesake, the cofounder and first medical director of the Ella Austin Health Clinic and co-developer of the East San Antonio Medical Center. Dr. Bryant also served as the first African-American president of the Bexar County Medical Society.
*Featured/top image: University of Texas Health Science Center at San Antonio. Courtesy photo.