Local diabetes fighter goes global with Discovery Health Channel documentary


Dr. Francine Kaufman has seen the incidence of diabetes skyrocket in the last 30 years. The pediatric endocrinologist is director of the Comprehensive Childhood Diabetes Center at Childrens Hospital Los Angeles, and she says the disease’s local increase is part of a worldwide phenomenon.

In Los Angeles, the number of adults with diabetes stands at about 600,000, or 8.6 percent of the population, up from 6.6 percent in 1997. Nationally, 20.8 million children and adults — about 7 percent of the population — have diabetes. Worldwide, more than 180 million people are estimated to have diabetes, a number expected to double by the year 2030.

The author of “Diabesity: The Diabetes-Obesity Epidemic that Threatens America and What We Must Do To Stop It,” Kaufman has been on the front lines of fighting these escalating numbers as a clinician, researcher and a former president of the Diabetes Association of America.

Now Kaufman is turning to the small screen to bring attention to this global epidemic in a one-hour, commercial-free Discovery Health documentary narrated by actress Glenn Close, “Diabetes: A Global Epidemic,” on Sunday, Nov. 18.

Kaufman spent six months visiting every continent except Antarctica to explore the challenges of diabetes as well as the success stories. Logging about 150,000 air miles, she visited clinics, met with government officials and spoke directly with patients.

“There’s a common theme: Diabetes can potentially devastate people’s life anywhere, both the countries with tremendous resources and the countries with almost no resources,” Kaufman told The Journal. “It knows no boundaries.”

Diabetes is an inability of the body to use or produce insulin, a hormone that regulates blood sugar. Over time, diabetes can damage the heart, blood vessels, eyes, kidneys and nerves. Ninety percent of people with diabetes worldwide have Type-2 diabetes, which is largely the result of excess body weight and physical inactivity. Lifestyle changes can delay or prevent its development, which is why Kaufman is so passionate about the issue.

Kaufman’s journey began in December 2006 in Capetown, South Africa, during the 19th World Diabetes Congress. Traveling to the city’s outskirts, she saw the poor living in shacks that lacked running water or electricity. She visited a residential hospital where children receive care because their families cannot provide it. While some don’t believe in Western medicine, others suffer due to unreliable insulin delivery or a lack of resources to refrigerate the perishable animal hormone.

At each destination she visited, Kaufman found cultural factors that impact diabetes:

  • In Los Angeles, she focused on the largely Latino patient population, whose genetics and dietary customs pose problems. “I was raised on rice, beans, tortillas, meat and cheese,” explains one woman, whose weight had once reached more than 300 pounds.
  • In India, a country with a history of starvation, the populace largely perceives obesity as a sign of health and wealth. Street vendors sell fried foods on every corner, and the bikes that Kaufman had seen on her previous visit have been mostly replaced by scooters and cars. The cultural practice of bare feet poses particular challenges because diabetics often lose sensitivity in their feet. As a result, small cuts can go unnoticed until they become infected or gangrenous.
  • In Australia, a country associated with physical fitness, Kaufman learned that citizens are now more likely to watch sports than participate in them. And the country’s Aboriginal population, whose bodies are hardwired to store calories, have an astounding 50 percent prevalence of diabetes.

    However, Kaufman also saw some successes.

  • In Helsinki, Finland, the government’s proactive approach to prevention showed that those at high risk of developing diabetes could decrease their risk by 58 percent. Peka Puska, director general of the National Public Health Institute, told Kaufman, “We have to change the environment so the healthy choice is the easy one.”
  • In India, Kaufman visited a comprehensive clinic that treats 100,000 patients and addresses every aspect of diabetes care. In one location, patients see specialists such as dentists, dieticians and opthalmologists, and can purchase items including medication, food and special shoes.

“I would love to be able to replicate that in Los Angeles,” she said.

While Kaufman did not visit Israel as part of the documentary, she said she was there last month for a symposium hosted by D-Cure, an Israeli nonprofit organization that funds diabetes research and collaborates with research projects around the globe.

“With its focus on healthcare and technology, Israel is likely to emerge as an international player in finding solutions [to the diabetes epidemic],” Kaufman said.

At the same time, Israel’s rate of diabetes is 7.8 percent.

“It’s a struggle there like it is for all of us from cultures that intermingle nourishing with nurturing,” she said. “It’s hard to overcome how we were raised, where our grandparents were starving, and overweight was a sign of health.”

Whatever a nation’s specific challenges relating to diabetes, the disease is universally devastating when not managed, Kaufman said. She does, however, have the prescription.

“To manage it, you need a government that can give resources; a health care system that is focused on it; the environment in which you live supporting a healthy lifestyle; and, ultimately, your own personal choice of whether you’re going to do everything you can to combat this or not.”

“Diabetes: A Global Epidemic” will air on Discovery Health, Nov.18, 9 a.m. For more information, see http://health.discovery.com/centers/diabetes/diabetes.html and

http://www.d-cure.org/English/

Q and A With Dr. Francine R. Kaufman


 

Obesity has reached record rates among children and adults, bringing with it increased risk for developing diabetes and related health problems. In addition to the more than 18 million Americans currently living with diabetes, another 41 million are considered prediabetic, and are likely to develop the disease unless they take action.

In her new book, “Diabesity: The Obesity-Diabetes Epidemic That Threatens America — And What We Must Do to Stop It” (Bantam), Dr. Francine R. Kaufman describes how reversing these trends requires efforts from all levels of society.

The immediate past president of the American Diabetes Association and the head of the Center for Diabetes, Endocrinology and Metabolism at Childrens Hospital Los Angeles, Kaufman spoke with The Jewish Journal about the magnitude of the problem, its causes, and strategies for changing the course of this epidemic.

The Jewish Journal: How have rates of obesity and diabetes changed over recent years?

Dr. Francine R. Kaufman: There’s been such a huge increase that we’re now calling it an epidemic. And it’s not only affecting adults, but also children. The number of overweight children has tripled since 1970. Cases of Type 2 diabetes among children have grown from a negligible number in the early 1990s to about 25 percent of new cases today.

JJ: Why are we seeing so much weight gain among children and adults?

FK: Our lifestyles have markedly changed: The amount of physical activity has markedly diminished in the community setting, in homes and in schools. The amount of sedentary behaviors — such as television, computers, video games and instant messaging — has markedly increased. And the quality and quantity of food is markedly different.

JJ: You advocate applying the strategies used by the anti-tobacco movement to purveyors of fast food and junk food. Where does personal responsibility fit in?

FK: The fundamental difference between the anti-tobacco campaign and this issue is that everyone has to eat but no one has to smoke. In both cases, personal responsibility is important. People need to be concerned about their health and motivated to get active and eat appropriate amounts of quality food.

However, there are lots of people who don’t have the option to make these healthy choices. It’s not realistic to expect a woman who’s on welfare, has three kids and is working two jobs to go to the Whole Foods store — which she can’t afford — and have the luxury to cook this wonderful meal — which she doesn’t have time to do — and then go exercise with her children.

We have to be able to fit healthy behaviors into our daily lives rather than segment them out. Our work places, our communities, our schools and our faith-based organizations must allow us to make healthy food choices and engage in physical activity.

For example, it’s not easy to be healthy at most workplaces. Employee cafeterias offer fare that’s high in salt, fat and sugar. Vending machines sell sodas, candies and chips. Stairwells are dingy and hard to access. It doesn’t have to be this way. Workplaces could [offer incentives to] employees to be active, serve healthy snacks in their cafeterias and vending machines or subsidize employee gym memberships.

JJ: In your book, you describe how your Grandma Sadie, who eventually developed diabetes, grew up undernourished in Russia. Her diet changed when she came to American and was exposed to abundance for the first time. How does your grandmother’s experience parallel the experience of our society?

FK: In Los Angeles, there are still a lot of new immigrants who [don’t] have an abundance of food like we see here. After starving or having tremendous food insecurities, they come here and overindulge. My Grandma Sadie hid food. If she went to a restaurant, she took home all the rolls and the sugar. She couldn’t shake the mentality of scarcity.

The grandmas of my patients have tremendous impact on the health of their children and their children’s children — just like Sadie did for us. They don’t want to limit the amount of food their grandchildren can have and don’t understand why they should.

Also, many children in this country live in communities where all they see are liquor stores, convenience stores and fast food restaurants. It’s not the equivalent of living on the Westside. It’s hard to find a grocery store in some parts of town. The quality of the produce is not equivalent. The produce is more expensive and people have less money to spend.

JJ: These are formidable obstacles…

FK: I think there’s movement afoot to address these problems: The federal government, originally led by Health and Human Services Secretary Tommy Thompson, has promoted the message. Congressional leaders have become aware that we need to improve the health status of America. Locally, I chaired a task force for the Los Angeles County Board of Supervisors, who are putting the recommendations into action. And Los Angeles Unified School District’s ban on selling soft drinks was a clarion call to the nation.

JJ: So there’s hope.

FK: I’m very hopeful. There is positive change. We have to make these changes. If not, diabetes will devastate us. In 2002, diabetes cost the nation $132 billion. One in three children born in the year 2000 will develop diabetes in his or her lifetime. The New England Journal of Medicine just published and article projecting that this generation will not live as long as the previous one because of obesity-related diseases.