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.