The prevalence of type II diabetes is growing at an alarming rate; much to the concern of primary health care providers. In 2007, the CDC estimated 23.6 million people were diabetic. Out of those, 21.2 million people had type II diabetes. One-fifth of all healthcare dollars is used to treat diabetes or its sequella (Centers for Disease Control and Prevention, 2008). Researchers have demonstrated a strong correlation between obesity and type II diabetes (Mokdad, Bowman, Ford, Vinicor, Marks, & Koplan, 2001). While the exact mechanism of type II diabetes is not fully understood, the complications of uncontrolled diabetes such as blindness, renal failure and tissue necrosis are well recognized and predicable. Trends in type II diabetic patients show the gross majority coming from the obese population. In the absence of a causative pathology, becoming obese is the result of either a high calorie diet, lack of exercise, but usually both. The long road to becoming diabetic starts with food choices. Eating energy dense foods such as those with high fat and high sugars leads to excessive weight gain, leading to the elevated risk of diabetes (Mendoza, Drewnowski, & Christakis, 2007). These types of foods are typically less expensive per ounce than nutrient dense healthier alternatives. Low income African American families are vulnerable to the trap of buying these low cost, high energy dense foods. The obesity disparity between minority families and Caucasian families is causing an epidemic among the poorer populations of the United States. The prevalence of obesity in African Americans is 51% higher than non-Hispanic whites(need reference). The food choices of minority families make them susceptible to type II diabetes. The avoidance of sugar does not help in the prevention of diabetes in obese patients because??? The bodyââ‚¬â„¢s ability to store excess intake of food, an evolutionary necessity, causes cellular inflammation, which leads to resistance of energy intake. That energy int eh form of glucose stays in the blood along with the insulin. The elevated blood glucose stimulates more insulin production and eventual exhaustion of the Pancreatic Beta cells
Minorities do not eat vegetables. The vitamin rich foods contain antioxidants
The perpetuating condition of obesity causes cellular changes which renders liver, muscle and adipose tissues resistant to insulin. Obesity leads to excess fatty acids circulating in the bloodstream which has been directly associated with a suppression of insulin signaling. The insulin receptor substrates of muscle, liver and adipose cells are down regulated and resistant to the increasing levels of glucose entering the target cells (Lin & Sun, 2010). At the same time the pancreas is producing excess insulin in response to the lack of glucose uptake, leading to the burnout of the insulin producing cells. The classic presentation of type II diabetes is as predictable as the diets of those who suffer from it. While excess glucose is responsible for the diagnosis of diabetes, the foods that lead to obesity predisposes overweight people to diabetes. The amount of corn based sweetener has steadily increased since 1966 which positively correlates with the increase in obesity among minorities (Haley, Reed, Lin, & Cook, 2005).
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Self reported dietary studies conducted in 2006 showed African Americans ate more energy dense foods than Caucasians (Mendoza, Drewnowski, & Christakis, 2007). Minority families choose the foods they eat based upon cost, availability, and advertising. The low cost of energy dense foods compared to nutrition dense foods may be a deterrent in healthy food choices for low income families. High fat, high sugar foods are least likely to be influenced by inflation or seasonal costs (Monsivais & Drewnowski, 2007). The rising prices of fresh fruits and vegetables may prevent these families from buying them. Another allure of energy dense foods is the typical shelf life that lasts longer than fruits and vegetables which must be eaten within a few days. For families that have transportation issues, going to grocery stores often may not be feasible.
Minorities may have limited access to nutrient rich foods such as fruits and vegetables. Poor access to low-energy dense nutrient rich foods forces low income minority families to buy foods that lead to obesity. 2.3 million households in the United States, or 2.2 percent of the population, live more than a mile away from a supermarket and do not have access to a vehicle (Ver Ploeg, 2009). These families must rely on public transportation for grocery shopping, if the bus route passes by a grocery store. This difficulty forces them to buy food at convenience stores in which the prices are typically 30% higher for the same item at a supermarket (Leibtag, Barker, & Dutko, 2010). They end up buying less food or energy dense food. These convenient stores typically do not have fresh fruit or vegetables available. If these families wanted to eat healthy, they are at a disadvantage merely by the limited available food around them. A vicious cycle is created when the only food available is high fat, low quality food bought by low-income families. This shows the store owners the high demand for the cheap food and influences their choices of foods offered for sale. Research conducted in California showed supermarkets located in low income neighborhoods are less likely to offer more expensive healthy alternatives such as whole wheat breads or skinless chicken compared to higher income neighborhoods (Jetter & Cassady, 2006). These families are not able to choose healthier items even if they wanted them.
Government agencies that support low income families may be inadvertently promoting obesity and an early diagnosis of diabetes. The UDSA started the Thrifty Food Plan (TFP) in order to help low income families plan meals. The TFP does not have the healthiest choices of foods in its recommendations. Meal plans are based upon food standards for families who are not struggling with obesity. Low fat, low sugar plans are not presented (U.S. Department of Health and Human Services, 2005). Advertisers marketing towards low income families may influence food choices. Fast food advertising targets minorities by running television ads which feature actors of that ethnic group. This tactic brings more minorities into fast food restaurants. These advertisements promote the idea of feeding the entire family for a low cost. More fast food ads play during shows typically watched by African American families compared to Caucasian families. African American children typically watch more television after school than Caucasian children leading to more time watching these television food advertisements (Kumanyika & Grier, 2006).
The allure of a meal for only a dollar has attracted many minority families to fast food restaurants. The current economic downturn has slowed most restaurant sales, although McDonalds is an exception. In 2002, they lowered prices of certain popular high fat items in order to attract families who want to go out to eat, but cannot afford to because of the economic downturn since late 2001. Today, the dollar menu has been imitated by other fast food restaurants based upon its success in drawing in customers. They recently added a large soda to that menu allow parents to feed their family for a dollar or two each. They can drink all the soda they want while safely playing in the indoor playground. One problem low income families face is the lack of safe parks and fields for children to play in; fast food restaurants capitalize on this fact. Geographic analysis showed that fast food restaurants are more abundant in low income neighborhoods compared to more affluent neighborhoods (Block, Scribner, & DeSalvo, 2004). The close proximity of these fast food restaurants, while allowing for more jobs may promote, unhealthy eating habits of the workers, who tend to be low income minorities.
Minority family demographics influences the food choices made by family members. Minorities have more single parent families than non-minority families. More often single mothers are the only parent in these types of families. Living on a single income, these exhausted mothers have to decide whether to cook a healthy meal or heat up a high fat microwave meal for their children. Picking up fast food on the way home may often be the family meal. Some of these mothers in single parent families must work two jobs in order to pay rent, day care, and food. This often leaves the children on their own for their food choices. The inability of parents to control their childrenââ‚¬â„¢s food choices may lead them towards obesity. Many of these minority children watch television more often than non-minority children for after school activities. These children are exposed to more unhealthy food television ads which may later influence their food choices (Kumanyika & Grier, 2006).
The problem of obesity in minorities, and especially minority children has become an epidemic with consequences in healthcare and primary care. The growing number of diabetics will lead to primary healthcare providers being inundated with diabetes checkups. This may prevent others from seeing the provider or cause a larger workload for those family practice providers who are already in short supply (National Resident Matching Program, 2010). Although public education educates about the dangers of obesity, the growing numbers of obese minorities show the failure of these programs. Families now have to choose between buying quality food for their children and buying medicine for the parent or parents diagnosed with diabetes. Medical bills are typically 2.3 times higher for individuals with diabetes (Centers for Disease Control and Prevention, 2010). For low income families, the cost of healthcare can be devastating. This dilemma creates a downward spiral that teaches children that food quality is unimportant. Early diagnosis of type II diabetes is becoming more common in minorities; making them the most vulnerable for the many complications of diabetes (Centers for Disease Control and Prevention, 2010).
The argument of genetics vs. social factors when assessing risks becomes unclear because obesity in minorities tends to run in families, yet the family members usually eat the same types of foods.
Complications of uncontrolled diabetes can lead to amputations and blindness severely affecting the income of the already suffering families. Missed work due to medical appointments compounds the financial burden that already faces low income families. Complications of type II diabetes such as renal disease, peripheral vascular disease and heart failure could costs these families over $14,000 per year (Pelletier, Smith, Boye, Misurski, Tunis, & Minshall, 2008). Many of the main income earners will suffer amputations because of type II diabetes. Over 82,000 amputations are performed annually because of diabetes (Centers for Disease Control and Prevention, 2010). The cost of healthcare for the parents will transfer to the obese children creating a financial strain that will be felt for generations. These children growing up in the culture that promotes obesity will be faced with their own metabolic syndrome and eventual diagnosis of type II diabetes. According to the CDC, 24% of African American females aged 6-19 were reported as obese in 2006 compared to 14.4% of Caucasian females (Centers for Disease Control and Prevention, 2009). Current trends in minority childhood obesity shows how real the problem is.
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Minority parents who grew up poor and hungry have a tendency to overfeed their children (Hughes, Sherman, & Whitaker, 2010). Children of normal weight who grow up in an obese family may be deemed scrawny; family members may encourage overeating by commenting on how skinny the child looks compared to the other overweight children. When many family members are obese, it will be percieved to be the norm, or possibly attributed to a false genetic factor by the family, when in fact overeating energy dense foods is the actual cause. Research conducted in Kentucky showed that many mothers receiving food assistance who have overweight children did not feel their child was overweight (Hughes, Sherman, & Whitaker, 2010).
While the increased rates of diabetes among minorities do not prove risk, it highly suggests it. The current economic downturn combined with the promise of affordable healthcare for all will only promote the unhealthy food decisions made by minorities trying to save money. The growing trends in obesity and type II diabetes is becoming a worldwide problem. What was once a problem in feeding people from other nations is now a probem in overfeeding them with energy dense, nutrient poor food. Immigrants from these countries are coming to the United States already suffering from metabolic syndromes. The bombardment of fast food commercials and The world health organization recommends decreasing energy dense foods (Rolls, Drewnowski, & Ledikwe, 2005).
Inflammation of tissues has been one theory in the damaging effects of diabetes. Insulin suppresses inflammatory proteins such as glycogen synthase kinase-3. The eventual decline in insulin production and utilization by target cells will allow these cells more susceptible to the inflammation and apoptosis (Dugo, et al., 2006).
Another consequence of diabetes is the decrease in incretin hormones that augment postprandial insulin spikes (Vollmer, et al., 2009). The suppression of these hormones further causes blood glucose to increase.
African Americans who have a relative with diabetes are more likely to be better educated about the disease (Gary, et al., 2007).
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