March 11, 2008

Black Youths: the New Face of Diabetes

As African-American youngsters have become heavier, half of them are predicted to be diagnosed with the disease during their lifetime To friends and family, Bryan Moore, 14, was always considered to be a cute, chubby kid who loved fast food. "Pizza, burgers, fries, candy, I would eat anything that tasted good," says the Baltimore ninth-grader who, at his heaviest, weighed 220 pounds.

It wasn't until one day at dinner that his mother, Virginia, realized that her son's weight was nothing to take lightly. "I will never forget that day. When we went out to dinner, he got really tired and sleepy," she says. "He couldn't sit up."

"I kept dozing off, and my mom kept waking me up," Bryan says. "I was scared. I thought that I was going to die."

Moore rushed her son to the emergency room. His situation was so serious that doctors kept him in the hospital three days. The diagnosis shocked his mother. Bryan's excessive weight had triggered type 2, or adult-onset, diabetes. He was eating himself to death.

"I didn't know," Moore says of her son's condition. "Everyone would say to me, 'He's just so cute and chubby.' No one told me that there could be underlying dangers to my son being overweight as a kid."

Type 2 diabetes, which in 1994 represented less than 5 percent of new diabetes diagnoses among youths, now accounts for as much as 50 percent of the new cases in children, according to latest estimates from the Centers for Disease Control and Prevention (CDC). As many adolescents are now being diagnosed with type 2 diabetes as those with the less-ravaging type 1 form, which traditionally victimizes younger children.

The increasing rate of type 2 diabetes among children is believed to be a result of the dramatic rise in adolescent obesity, particularly central obesity or belly fat, which has been found to trigger the body to resist insulin.

And nowhere can that weight gain be seen more than in African- American youths. Today, close to 24 percent of African-American children are obese (a 10-year-old child, for example, who is 4-foot- 6 is considered to be overweight if he or she weighs more than 97 pounds, according to the Body Mass Index). In fact, the rate of obesity for Blacks is double what it was just two decades ago and twice the rate of White adolescents.

Excessive weight gain coupled with a genetic predisposition for diabetes among African-Americans has made Black youths (ages 10 to 19) the new face of type 2 diabetes.

According to the World Health Organization, worldwide obesity and obesity-driven diabetes has reached epidemic proportions. In fact, obesity has overtaken AIDS and malnutrition as the top health problem in the world, and diabetes has become the first non- infectious disease that, the health group says, presents "a significant heath threat" to the world.

In some U.S. cities, childhood type 2 diabetes has increased fivefold in the last decade, with overweight African-American adolescents accounting for nearly 90 percent of the new cases. In fact, the CDC predicts that if the problem persists, half of the AfricanAmerican children who were born in 2004 will develop diabetes during their lifetime.

"What we see going on in our community rises to the level of an epidemic," says Dr. Eugene E. Wright Jr., medical director for Primary Care Services for Cape Fear Valley Health System in Fayetteville, N.C.

Wright says "the perfect storm" has created an explosion of diabetes among Black youths. "You have the cultural and ethnic proclivity for developing diabetes by being African-American, you have increased obesity because of what we see in terms of the foods that our children are exposed to, then, on top of that, children are less active relative to 20 years ago," he says. "You take those three factors together and those lead to this explosion of diabetes that we see in our children."

The diabetes epidemic in children has prompted the American Diabetes Association (ADA) and the American Academy of Pediatrics (AAP) to jointly recommend that youths who are obese and have a first- or second-degree relative (such as one's mother or cousin) with diabetes be tested for the illness around age 10. This would result in testing about 10 percent of all young people.

Wright, who has diagnosed children as young as 9 with diabetes, says the effect of the disease on youths will be devastating. "The complications of diabetes take 10, 15, 20 years to develop," he says of complications, including blindness, kidney failure and amputations. "When you develop diabetes at age 40, the complications will start to occur around age 60, which is not good, but at least you have lived a relative healthy life. But when you develop diabetes at age 10, it puts you into those complications much earlier."

To make matters worse, medical experts say that half of the children diagnosed with diabetes don't comply with care recommendations, sometimes because of teasing by peers or lack of family support. Also, the silent nature of type 2 diabetes, whose damage isn't immediately identifiable, can lead children and their parents to ignore healdi recommendations.

Dr. LaShawn McIver, director of the Baltimore City Health Department, works with youths on issues of health and violence. She has teamed with the ADA on a series of community discussions with youngsters about type 2 diabetes. "People don't understand that their kids are at risk for developing diabetes," she says. "The face of diabetes in the past has been a grandmother...but today, it's not just your grandmother's disease."

McIver says that her research has found that kids increasingly forgo physical exercise for video games and television, and fresh fruits and vegetables for fast food. "Kids don't, or can't, go out to play anymore; some schools don't even have physical education classes anymore; and we have turned into a microwave society, where we are making terrible food choices for our family," says McIver, who is working with the ADA on programs and legislative initiatives targeting diabetes among youths.

At one recent meeting McIver held with a group of six Baltimore children who were determined to be at-risk for diabetes, the silence was deafening when she asked them to recall the last time they had eaten a vegetable. Finally, LaBria Brown, 16, explained that she doesn't like vegetables.

A University of California study in 2005 evaluated kids between ages 10 and 16 to determine the short-term effects of increased exercise and a healthy diet on diabetes-related problems. During a two-week period, the participants ate a low-fat, high-fiber diet and exercised two to two-and-one-half hours a day. Researchers found improved ability to handle glucose and insulin, lower blood pressure and lower levels of fats in the blood.

McIver says that awareness among African-Americans is key to solving the problem. "A lot of the solution is in raising the awareness that the problem exists," she says. "While family history can't be controlled, nutrition and exercise can be changed for the better. It's something that we have to wake up and pay attention to. We've created a culture that is not healthy, and now's the time to undo that. We have to take control of our home again. We have to make better decisions because now it's not just our health that we are putting at risk, it's our children's as well."

Looking back at her son Bryan, Moore says that she now realizes that the warning signs-the excessive weight gain, the family history of diabetes (although she doesn't have the disease)-were there. Now, she has an urgent message for odier Black parents of overweight kids. "Pay more attention to your children and don't write it off as they are just cute, chubby kids," she says. "It's imperative for parents to ask questions. If I had been more proactive, maybe I could have caught it earlier or prevented it altogether."

Moore says that she and her son have now joined the YMCA and started walking together. Bryan has attended classes to learn how to eat better, and he has dropped 50 pounds. "Now I eat apples and other fruit. I eat healthy stuff," he says. "I'm trying to stay fit." And although he has to give himself an insulin shot every night before bed, he is positive about his future. "It's just a part of my life," he says. "There's nothing I can do now but hope for the best."

With growing concern about the diabetes epidemic, the new face of the disease is Black youths, including 14-year-old Bryan Moore, who weighed 220 pounds when he was diagnosed with type 2 diabetes last year.

Bryan Moore prepares to check his blood-glucose level, an activity he has to repeat several times a day as a part of managing his disease.

Daily insulin shots have become a way of life for thousands of youngsters who have been diagnosed with diabetes.

Diabetes and the African-American Community

* 13% (3.2 million) of all African-Americans age 20 or older have diabetes.

* 25% of African-Americans between ages 65 and 74 have diabetes.

* African-Americans are 1.8 times more likely than Whites to have diabetes.

1 in 4 African-American women older than 55 has diabetes.

* African-Americans are as much as 5.6 times more likely than Whites to suffer from kidney disease as a result of diabetes complications.

* African-Americans are 2.7 times more likely than Whites to suffer from lower-limb amputations. Source: American Diabetes Association

At a meeting with Baltimore youths who are at risk for diabetes, Dr. LaShawn Mclver (far right) talks to the teens about the importance of eating right, getting regular exercise and maintaining a healthy weight.

Diabetes Symptoms

* Frequent urination

* Excessive thirst

* Extreme hunger

* Unusual weight loss

* Increased fatigue

* Irritability

* Blurry vision

Diabetes by the numbers

* 20.8 million:

Total number of children and adults who have diabetes

* 6.2 million:

Number of people who have diabetes and don't know it

* 1 in 2:

Ratio of African-Americans who will develop diabetes if present escalating trend continues

* $132 billion:

Estimated yearly cost of diabetes

* 54 million:

Number of people who have pre-diabetes that will develop into diabetes without proper diet and exercise changes

* 2 million:

Number of adolescents ages 12-19 who have pre-diabetes

* 1 in 6:

Ratio of overweight adolescents who have pre-diabetes

Source: American Diabetes Association