Obesity, diabetes on the table at 2014 Family Impact Seminar

Legislators and other officials listen to a presentation by Ira Ockne, M.D., during the Family Impact Seminar.

The Mosakowski Institute for Public Enterprise at Clark University made its annual visit to the Massachusetts State House on March 26 to apprise policymakers on the toll that obesity, diabetes and cardiovascular disease is taking on the state’s residents, particularly those within low-income and minority communities.

“A Lot On Our Plate: Chronic Health Threats in Massachusetts” was the Institute’s fifth Family Impact Seminar, which attracts legislators and officials from various state and private agencies. Past seminars have delved into issues covering men’s mental and physical health, the recession’s effect on families, and the social and physical factors that put youths at risk.

Following introductory remarks from James Gomes, director of the Mosakowski Institute, and Denise Hines, Ph.D., Clark University research associate professor in psychology and the director of the Family Impact Seminars, three speakers offered views on some of the most pernicious health issues facing both Massachusetts and the wider world.

With their long legs, human beings are designed to live physically active lives, Ira S. Ockene, M.D., director of the Preventive Cardiology Program at University of Massachusetts Medical School, told the audience. We may not be the fastest sprinters in the animal kingdom, but we are only one of four animal groups built for endurance running, dating back to the species’ earliest days as hunters pursuing their prey on foot over long distances.

Unfortunately, in the contemporary world, cardiovascular disease is at epidemic proportions, largely because of our susceptibility to a variety of risk factors, many of them driven by a sedentary lifestyle and poor diet, Ockene said. High cholesterol, smoking, high blood pressure, low physical activity, diabetes and obesity are among the greatest culprits, he said, but they are often preventable and treatable. “Unlike diseases such as cancer, cardiovascular disease is not an inevitable part of human life,” he said.

Increasing one’s physical activity rather than eating fewer calories is the most important factor to losing weight and improving heart health because the human body requires a certain level of nutrients, Ockene said. Still, the American diet is proving problematic as it spreads to other countries and replaces low-calorie, high-fiber fare. Ockene cited one study that predicts by 2030 half the world’s diabetics will be in India.

He had three recommendations for public policymakers:

Improve access to healthy food by prioritizing nutritional access and education among citizens and through the promotion of community-based projects.
Increase the barriers to access tobacco. Ockene said the war against smoking has been “one of the great public health triumphs.”
Consider prioritizing infrastructure projects that promote physical activity, such as outdoor spaces for recreation and roadwork projects that emphasize sidewalk access.

One piece of good news, Ockene added, is that in the United States, death rates related to cardiovascular disease have decreased in the past 30 years by 50.1 percent for men and 49 percent for women, thanks largely to changes in lifestyle and improvements in medical therapies.

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An an elementary school student in Worcester in the 1960s, Christina Economos, Ph.D., recalled, her annual class photos typically included a couple of students who were overweight. Similar class photos today would stand in stark contrast, given that 16.9 percent of children ages 2 to 19 nationwide are obese, according to a 2009-2010 study. Obesity rates are worse among low-income, and black and Hispanic families, both in Massachusetts and across the United States, according to the National Survey of Children’s Health.

The rates of overweight and obese children in the United States have doubled in the last three decades, and the rates of adolescent obesity have tripled in the same time frame, said Economos, who is associate director of the John Hancock Research Center on Physical Activity, Nutrition, and Obesity Prevention; the New Balance Chair in Childhood Nutrition, and an associate professor at the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy and the School of Medicine, Tufts University.

Economos cited some progress in recent years, especially since First Lady Michelle Obama has made healthy living one of her primary causes. But Americans’ sedentary behaviors and a culture that spends billions marketing fast foods, with many of those ads targeted at children, has made the war on obesity a long, difficult slog.

Economos supplied an example of one city where a concerted effort to lower the risk of obesity showed positive results. Shape Up Somerville, a study Economos and her colleagues conducted from 2002-2005 in three elementary schools in Somerville, Mass., included a number of community-based interventions designed to prevent and reduce obesity among elementary school children. Through a number of measures ranging from enhancing time at recess to revamping the school lunch program to providing education to students and their families, the students’ Body Mass Index decreased and researchers reported a nearly 30 percent reduction in the rate of obesity.

Economos stressed that the effectiveness of the Shape Up Somerville program derived from the community’s willingness to partner with the schools and the researchers to create a culture where healthy living was a priority. In that vein, she recommended a number of national policies. Among them:

Focus prevention efforts on groups at risk (e.g., low-income and minority populations)
Start prevention efforts as early as early as infancy
Support intervention programs promoting robust, long-term community engagement and civic participation
Create policies for physical activity in school.

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As one of the fastest growing public health crises today, Type 2 diabetes wreaks havoc on bodies, burdens communities and boosts health-care costs.

Barbara Goldoftas, assistant professor of environmental science and policy, noted that the disease is a leading cause of blindness, kidney disease and amputations. The number of people with the disease has been rising since the 1950s, has climbed markedly since the 1970s, and has doubled in the last 10 years.

Why? No one knows for certain, Goldoftas said, but “an interconnected array of risk factors” has been identified as triggers. Poor nutrition, inactivity and sedentary activities, and overweight and obesity are cited as common contributors. As an environmental epidemiologist, Goldoftas also considers the “population perspective,” which factors in social and environmental determinants like the nature of neighborhoods, chronic stress, environmental contaminants and changes in “gut ecology” (the microbiota that inhabit our intestines).

Goldoftas conducts studies of type 2 diabetes in rural Nicaragua and found that, while the diet is traditional (little or no fast food) and the people are typically active, the disease is the leading cause of illness and death in the country. This conundrum has spurred a search for alternative explanations for the disease’s prevalence. (At this writing Goldoftas was awaiting data on possible contributing factors like pesticides and antibiotics.)

The lack of awareness about the disease among populations she’s worked with in Nicaragua and in Worcester’s Vietnamese community is alarming, Goldoftas said. Changes in diet and activity are typically more effective than medication, she said, but altering long-held traditions in food choices and preparation can be daunting.

She noted that diabetes disproportionately affects people with less education and lower income and varies by age, gender and race/ethnicity.

With such pronounced disparities by race/ethnicity, there is a need for culturally and linguistically appropriate programs, health information, and practitioners to help ease the burden among various groups who are greatly affected, she said. Programs that target youth, families and communities could reach pre-diabetics and the undiagnosed, and foster critical family and social support.