Nancy D. Schaefer, R.D., L.D.Ohio Department of Health Diabetes Prevention and Control Program

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

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

0

10

20

30

40

50

60

Men Women

Per

cen

t

Total Non-Hispanic WhiteNon-Hispanic Black Hispanic

Narayan et al, JAMA, 2003

1991-1992 1995

1999 2001

Diabetes Rates 1991-2001

County-level Estimates of Diagnosed Diabetes for Adults

aged ≥ 20 years: United States 2005

Ohio West Virginia

Kentucky

2005Percentage of adults ≥ 20 years old with

diabetes

Told by a doctor you have diabetes or sugar

11.30%

7.81%7.00%

0.73%

0.74%0.80%

1.35%

0.80%0.59%

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

0.16

AHRI 2006 BRFSS 2004 Ohio BRFSS 2004Nationwide

Per

cent

age

of R

espo

nses

Boarderline\Pre-Yes (Pregnant Female)Yes

Confidence Interval for ARHI "yes" is 9.91% to 12.69%Confidence Interval for BRFSS Ohio "yes" is "6.64% to 8.98%

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

Estimated prevalence of diagnosed and undiagnosed diabetes in people aged 20 years

or older, by age group, United States, 2007

2.6

10.8

23.8

0

5

10

15

20

25

20-39 40-59 60+

Age Group

Per

cent

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.

• 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

Obesity seems to be the driving force in this epidemic

•NO states obesity rates have dropped in the last two decades

•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

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

1998

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1998, 2007

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2007

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

1994

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

2000

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

Obesity

Causes:

•BMI > 30

• Overconsumption of energy (calories)

• Under Utilization of energy consumed

Obesity rates are highest in areas than are economically challenged

High School Graduation Rates in Appalachia

In populations with lower educational levels

Estimated Prevalence of Overweight, Obesity and Morbid Obesity

Among Adult Ohioans By Educational Achievement, 20051

EducationOverweight

(BMI 25.0-29.9)Obese

(BMI 30.0-39.9)

Morbidly Obese

(BMI 40 or greater)

Overweight or Obese

Less than High School

38% 19% 7% 64%

High School Grad/GED

38% 23% 4% 65%

Some College

28% 20% 4% 52%

College Graduate

39% 19% 2% 60%

1Source: Behavioral Risk Factor Surveillance System; Chronic Disease and Behavioral Epidemiology; Surveillance – Prevention; Ohio Department of Health, 2006.

Chronic Disease Incidence Increases with

Increased Rates of Obesity• Cardiovascular Disease

• Asthma

• Arthritis

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

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)

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•

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 CommercialsAND…a model for our little girls to

strive for…BARBIE

• Seven feet tall

• 17 inch waist

• ½ a liver

• 2 inches of colon

• Neck would not support the weight of her head

A Model for Mobilizing Community Change

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

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

Train the Trainer

Skill Building◦Coalition Building◦Community Assessment around Diabetes

◦Intervention Planning and Implementation

◦Evaluation

Ongoing Support System

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

$

CommunityCoalitions

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.

67 Coalitions9 States

8

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

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

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

$10,000 Startup Grant

Diabetes Today Skills Training

Continued Technical Assistance

Leaders’ Training: Stanford Chronic Disease Self Management Program

Assistance in Program Evaluation

Event TypeEvent Type Number of EncountersNumber of Encounters

Physical Activity ProgramPhysical Activity Program 11,26511,265

Healthy Eating Programs Healthy Eating Programs 6,6526,652

Health Screening EventsHealth Screening Events 8,3888,388

Health Education EventsHealth Education Events 25,46225,462

Number of People in Support GroupsNumber of People in Support Groups 3,2933,293

Coalition Meeting AttendanceCoalition Meeting Attendance 802802

Total Encounters for 2007 Total Encounters for 2007 530,037530,037

Social Marketing

(estimated number of people reached)

=474,175

Generated $108,865 in in-kind contributions!

Volunteer labor

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

Legislators Families Individuals Restaurants and food producers

It has been said… Our kids……

Richard Crespo, PhD◦crespo@marshall.edu

Shelia Plogger◦splogger@marshall.edu

Center for Rural HealthMarshall University

Darrlyn Cornelius-Averhart, MPH, CHES◦ DCorneliusAverhart@cdc.gov

Rita V. Díaz-Kenney, MPH, RD, LD◦ rvd1@cdc.gov

Center for Disease Control & PreventionDivision of Diabetes Translation

CONTACT:

Nancy D. Schaefer, R.D., L.D.PH Nutritionist/Health EducatorOhio Department of HealthDiabetes Prevention and Control Program

Nancy.Schaefer@odh.ohio.gov