Diabetes rates have doubled in adults in New York City in the last eight years, according to a recent report from the Department of Health (pdf file), which says the disease is now "epidemic" in people of all ages. Eight percent of the population now suffers the condition, which is the sixth leading cause of death in the city. Amongst children, however, the rate may have risen even more sharply, according to physicians who treat the condition in the community.
"The increase has been dramatic," says Dr. Yolaine St. Louis, chief of pediatric endocrinology at Bronx-Lebanon Hospital and a spokesperson for the American Diabetes Association. Nationwide estimates put the rise at between four and tenfold amongst kids.
Diabetes is a condition in which the body stops responding to insulin, a hormone produced by the pancreas which tells cells to remove sugar from the blood for use as energy and for storage. Two forms are most common: type I, which is a genetic condition in which the immune system kills off insulin-producing cells and type II, which is associated with obesity. In type II diabetes, cells become unable to properly respond to insulin. Type II accounts for up to 90 percent of all cases — and is the form that has been increasing.
In fact, type I is also called juvenile diabetes, because it was once believed that Type II never, or only rarely, affected children. Recently, however, the proportion of children with Type II diabetes has skyrocketed.
Says St. Louis, "I have been working in this area for fourteen years. When I first started, about two to ten percent of cases amongst children were type II, now it's 30 to 35 percent."
The epidemic has hit hardest people of color, and those who are poor — populations which greatly overlap in New York. There seem to be both cultural and genetic reasons why African Americans and Latinos are at higher risk for both obesity and diabetes, and there are environmental reasons why in developed countries, the poor are vulnerable.
"I see a population in Nassau County as well as in the Bronx," says St. Louis. "Even amongst the kids who are more well-to-do, those with an [African American or Latino] background still have more obesity and diabetes." This could be due to a "thrifty" gene, which tells the body to store large amounts of fat in case of famine. In the past, this gene would have given people a survival advantage because people with the gene could store more food from times of plenty for times of scarcity. Now, of course, it can harm.
Cultural factors — such as a common belief amongst Hispanics that thin children are unhealthy — could also play a part. "Black and Hispanic people don't want to be thin like models and it's positive not to worship thinness, but there's also a healthy limit. We cannot as a community be getting this overweight. It has serious health consequences."
The highest diabetes rate in the city is in East Harlem, where 14.9 percent of adults are affected. The hardest hit ethnic group is Hispanics; 12.2 percent of Latino adults have the condition.
Rising rates amongst children foretell an even greater epidemic in the future, if steps are not taken to fight it. St. Louis says that when she first started practicing in the Bronx, it was rare for her to see a child who weighed 250 pounds. These days, she sees such a new patient monthly, sometimes weekly. "You have to be close to 500 pounds to impress me now," she says, sadly.
So what has changed recently to spur such a shocking increase in obesity and its consequences? Genetics, of course, and many cultural practices, do not change rapidly. But recent research has shown that food portion sizes have grown tremendously in the last decade and that people are becoming less and less active.
Lack of safe streets and play areas reduce opportunities for poor kids to exercise even further. Budget cuts now mean that in many city schools, kids have gym class just once a week. "One kid told me that in his school, some grades have no gym. Grades 3, 5 and 7 have gym-but 2, 4 and 6 don't," says St. Louis, who adds, "If gym class is over-filled, the teacher is probably not making sure that the fat kid in the back is participating."
School lunches, however, are not a big culprit. St. Louis says, "No one is getting fat on school lunch. They all hate it." Also, though the food tends to be fatty, the portion sizes are not overly large and schools have recently added things like skim milk, which help.
"After school, they do all this academic stuff," says St. Louis, "And that's great but there is very little physical activity." St. Louis says that while there are organizations like the Police Athletic League and the Boys and Girls' Club in the Bronx, many parents don't know how to get their children involved and need to be given more information.
For adults, making major lifestyle changes in diet and exercise is difficult. For poor children, there are even more barriers. Fast food is cheap and readily available, while fresh fruit and vegetables are more expensive and harder to find in poor neighborhoods.
Fortunately, with diabetes, small changes can make a big difference, and that is how St. Louis is able to help her patients. "A lot of parents don't realize that going from 300 pounds to 280, that's a big deal. It may make the difference between taking one medication or two and the difference between eye disease later in life or none."
St. Louis doesn't tell a patient, for example, that he has to lose 100 pounds or start exercising every day. Research finds that people told to make such huge changes are usually too daunted to start, and get discouraged. Instead, she praises kids for small steps — walking home from school once a week, losing one pound, or even just stabilizing and not gaining.
Since it is hard to get kids to worry about future consequences, which with diabetes are particularly dire and can include blindness, limb amputation and shortened lifespan, St. Louis focuses on teaching them about how diabetes could hurt them in the near term. If it is not properly controlled, diabetes in children can lead to lifelong short stature, because it hinders development. Also, the disease can dramatically affect school performance because blood sugar problems can cause headaches and difficulty concentrating.
St. Louis runs a support group called Sugar Babes, for kids with diabetes and their families. In it, participants discuss how to make small, manageable changes and what to do when kids are resistant. She mentions making more such groups available, getting more fresh fruits and vegetables into schools and poor communities, improving public safety so that kids can play outside, more gym classes as important steps to fight the epidemic. "All of these are issues that as a city we need to address," she says.
Maia Szalavitz is author, with Dr. Joseph Volpicelli, of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." She writes frequently on health, science and public policy for the New York Times, New York Magazine, the Village Voice, and other publications.