Diabetes: The State of the Problem in Appalachia

1. Diabetes: The State of the Problem in Appalachia Nancy D. Schaefer, R.D., L.D. Ohio Department of Health Diabetes Prevention and Control Program

2. Objectives for Today • Identify the problem of type 2 diabetes as a national concern that can be prevented or delayed • Describe the risks linked with diabetes in the Appalachian region that are greater than other parts of the country

3. 2007 World Diabetes Prevalence

4. Prevalence of diagnosed and undiagnosed diabetes in the United States, all ages, 2007 • Total: 23.6 million people or 7.8% of the population have diabetes. • Diagnosed: 17.9 million people (76%) • Undiagnosed: 5.7 million people (24%) • 57 million people are estimated to have pre-diabetes

5. Estimatedlifetimerisk of developing diabetes for individualsborn in theUnitedStates in 2000 Narayan et al, JAMA, 2003

6. Diabetes Rates 1991-2001 1991-1992 1995 1999 2001

7. County-level Estimates of Diagnosed Diabetes for Adults aged ≥ 20 years: United States 2005

8. 2005Percentage of adults ≥ 20 years old with diabetes Ohio West Virginia Kentucky

10. What is driving this epidemic? • People are living longer • Better medical care • Improved medications and treatments • High-risk populations are increasing • Those at a higher risk: • African American • Hispanic/Latino • Obesity rates are increasing • Vitamin D Theory

11. CDC. National Diabetes Fact Sheet, 2007. Source: 2003–2006 National Health and Nutrition Examination Survey estimates of total prevalence (both diagnosed and undiagnosed) were projected to year 2007.

12. 3.7 million, or 14.7% of all African Americans aged 20 years or • older have diabetes. • African Americans are 1.6 times more likely to have diabetes as • non Hispanic whites. • Twenty-five percent of African Americans between the ages of • 65 and 74 have diabetes. • One in four African American women over 55 years of age has • diabetes • 10.4% of the Hispanic Population have diabetes

13. Obesity seems to be the driving force in this epidemic • More than one third of U.S. adults—more than 72 million people—and 16% of U.S. children are obese. • Since 1980, obesity rates for adults have doubled and rates for children have tripled. • Obesity rates among all groups in society—irrespective of age, sex, race, ethnicity, socioeconomic status, education level, or geographic region—have increased markedly • NO states obesity rates have dropped in the last two decades

14. The Health Consequences of Obesity • Coronary heart disease • Cancer (endometrial, breast, and colon) • Hypertension (high blood pressure) • Dyslipidemia (high total cholesterol or high levels of triglycerides) • Stroke • Liver and gallbladder disease • Sleep apnea , asthma and respiratory problems • Osteoarthritis (degeneration of cartilage and underlying bone • within a joint) • Cataracts…ask me how! • AND…type 2 diabetes

15. Obesity Trends* Among U.S. AdultsBRFSS,1990, 1998, 2007 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1998 1990 2007 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

17. Age-adjusted Percentage of US Adults who where Obese or who had Diagnosed Diabetes 1994

18. Age-adjusted Percentage of US Adults who where Obese or who had Diagnosed Diabetes 2000

20. Obesity • Causes: • BMI > 30 • Overconsumption of energy (calories) • Under Utilization of energy consumed

21. Obesity rates are highest in areas than are economically challenged

22. In populations with lower educational levels High School Graduation Rates in Appalachia

23. Estimated Prevalence of Overweight, Obesity and Morbid Obesity Among Adult Ohioans By Educational Achievement, 20051

24. Chronic Disease Incidence Increases with Increased Rates of Obesity • Cardiovascular Disease • Asthma • Arthritis

25. Causes for Obesity • Poor Nutrition: • Food Affordability and accessibility • Confusion by consumer about what is appropriate • Easy access to fast food that: • Relatively economical • Heavily promoted by the media to children • Continues to provide food that is devoid of nutrition and becoming higher in calories/fat

26. Applebees Low Fat Choices Fiesta Lime Chicken • 1285/47…..2 ½ Big Macs • Low Fat Chicken Quesadilla • 742/14…1 1/3 Big Macs • Asian Salad Chicken Salad- Low Fat • 714/9…1 1/3 Big Macs • (121 Grams Carbohydrate) • Grilled Chicken Pasta-Low Fat • 873/9…1 2/3 Big Macs • (134 grams Carbohydrate)

27. Other causative factors for obesity • Inactivity • Too much screen time-TV, Video Games- • Computer, etc. • Fear of being outside • Too much packed into each day…fatigue • Inaccessible or unavailable facilities • The more overweight a person is…the less able • they are to exercise • Age and arthritis pain • Infrastructure…the Built Environment promotes • travel by car

28. The Greatest Dichotomy of the Obesity issue is: • More than 2/3 of the population is overweight or obese and: • Those who are: • Discriminated in employment • Viewed as lazy/stupid/incompetent • Constantly given messages of unrealistic , unproven and sometimes dangerous weight loss methods: • Diet Books/videos/internet information • Even our children are bombarded with messages that are conflicting: • Fast food Commercials • AND…a model for our little girls to strive for…BARBIE

29. If Barbie was a real human • Seven feet tall • 17 inch waist • ½ a liver • 2 inches of colon • Neck would not support the • weight of her head

31. Appalachian Diabetes Control and Translation Project A Model for Mobilizing Community Change

32. Appalachian Region • 410 counties in thirteen states • Appalachian Regional Commission (ARC) formed in 1960’s from mandate by Congress to address poverty developed socio-economic formula • distressed counties (77) • All of coalitions in this project are in distressed counties

33. Diabetes Today Goal • To provide community leaders with tools to work together to plan, implement and evaluate community based programs to prevent and control diabetes and it’s complications

34. Diabetes Today Overview • Train the Trainer • Skill Building • Coalition Building • Community Assessment around Diabetes • Intervention Planning and Implementation • Evaluation • Ongoing Support System

35. Diabetes Today - Key Activities • Raise awareness of the impact of diabetes among specific communities • Mobilize communities to conduct community assessments and build grassroots' level diabetes coalitions • Prepare a collective action plan • Implement and evaluate activities

36. Partnerships $ ARC CDC Community Coalitions Marshall University

37. Project Objective Help people living with diabetes, control their diabetes and prevent the disease in those who may be at risk. Fund county-level coalitions to organize around the problem of diabetes: planning, Implementing, and evaluating.

38. Diabetes Coalitions 8 67 Coalitions 9 States

39. Application Process • RFP’s once a year • Purpose • organizing or strengthening existing coalitions in distressed counties • address diabetes and its related chronic diseases • Eligible Applicants • Community groups and non-profit organizations

40. Funding • Grant Amount: $10,000 • Qualified partner designated as the fiscal agent receives funding • Full amount of the grant given after plans are written and approved by the whole coalition • No end date • Use of funds • Programs that engage people in healthy eating, physical activity, chronic disease self-management and awareness building

41. Key Elements of the Model for this Project Funding partnership of Federal agencies  ARC and CDC The dollars from one agency are stretched by a match from the other  for $5,000 get a $10,000 project. Regional scope for the development of county coalitions  a coordinated effort so that it is not an array of individual projects

42. What the Coalitions Receive? $10,000 Startup Grant Continued Technical Assistance Diabetes Today Skills Training Leaders’ Training: Stanford Chronic Disease Self Management Program Assistance in Program Evaluation

43. Community Health Encounters

44. In-kind Contributions & Social Marketing Generated $108,865 in in-kind contributions! Volunteer labor Social Marketing (estimated number of people reached) = 474,175

45. Other Programs in the Planning Stages: • ODH will be training all Ohio Stanford CDSMP master Trainers with the Diabetes Module to take to local communities via peer leaders • CDC will be sponsoring primary chronic disease prevention by training Master Trainers to bring Lifestyle Interventionists to local communities

46. We Need Help From All Ohioans • Legislators • Families • Individuals • Restaurants and food producers

47. It has been said… Our kids……

48. CONTACT: For Diabetes Today Coalition Building Information • Richard Crespo, PhD • crespo@marshall.edu • Shelia Plogger • splogger@marshall.edu Center for Rural Health Marshall University

49. CONTACT: • Darrlyn Cornelius-Averhart, MPH, CHES • DCorneliusAverhart@cdc.gov • Rita V. Díaz-Kenney, MPH, RD, LD • rvd1@cdc.gov Center for Disease Control & Prevention Division of Diabetes Translation

50. CONTACT: Nancy D. Schaefer, R.D., L.D. PH Nutritionist/Health Educator Ohio Department of Health Diabetes Prevention and Control Program Nancy.Schaefer@odh.ohio.gov