Kansans: Getting bigger than you think.
Chances are that state slogan won’t be printed on bumper stickers anytime soon. But, many health officials believe it’s a message that needs to be conveyed to the state’s residents.
In 2008, more than one in four Kansans were considered obese — a number that has increased by 76 percent in the past 15 years.
With extra weight come serious consequences. Chief among them is the explosion in the number of adults diagnosed with type 2 diabetes.
“’Epidemic’ is a strong word and, yet, that is exactly what this is,” said Jon Stewart, CEO of the Leo Center, which offers health care through its medical clinic. “This isn’t a virus. This is not a bacterial infection. This is born largely out of choices people make again and again and again.”
A tidal wave
About 170,000 people in Kansas have diabetes, and another 113,000 Kansans are estimated to have the disease but have not been tested for it. In 2008, 7.7 percent of the Kansas population had diabetes. Fifteen years ago, the number was at 4.1 percent.
“We are looking at something that was once a rare disease that is becoming increasingly common. And it is becoming more common every year,” said Jason Eberhart-Phillips, state health officer for the Kansas Department of Health and Environment.
Along with ‘epidemic,’ Eberhart-Phillips uses a more colorful description for the number of escalating diabetes cases: a tidal wave.
So, how big of a tidal wave is it?
Children born in the year 2000 have a one in three chance of becoming diabetic.
“Frankly, when it gets to that point, that is going to be so big a hole on our economy. You can kind of forget about all the other things we would like to do in terms of education and improving the quality of life for people,” Eberhart-Phillips said. “Because it is going to be a matter of survival and trying to contain the exploding cost this totally preventable problem is causing us.”
Last year, Lawrence Memorial Hospital had 7,533 cases where diabetes was a first or secondary diagnosis. The Leo Center saw about 2,000 patients with diabetes.
Health Care Access served 78 diabetes patients, who visit three to four times a year. The clinic used to have a doctor check on insulin-dependent diabetic patients once a month. Today, that just isn’t feasible.
“There are so many people on insulin there is no way one person, once a month, can do that,” said Lori Winfrey, the clinic manager at Health Care Access.
“We treat diabetes every day here. And I would say that is standard in most practices,” she said.
An entire economy
Diabetes is an expensive disease.
Self-employed and diabetic, Glenn Bartlett spends $300 a month on medicine and had to shell out almost $14,000 on medical bills last year.
“And I never went to the hospital,” the 56-year-old Eudora man said.
Diabetics have to test their blood sugar daily, sometimes three to four times a day. Those test strips run about a dollar apiece and over a year can add up to more than $1,000.
Then there are the blood sugar monitors, medication and, for more severe diabetics, insulin.
Now take what Bartlett pays in a year and multiply that by the 23 million other Americans who have diabetes and then add in the complications that accompany the disease: blindness, kidney failure, amputation and heart attacks.
The number is so large — $174 billion — that if what Americans spend on diabetes were a country, its economy would rank 45th in the world.
To treat a diabetic costs $11,744 a year. Much of that cost is picked up by health insurance and Medicaid or Medicare. In the end, it is estimated that every Kansan has to pay $566 a year for diabetes through higher health insurance premiums and the added burden on the Medicaid and Medicare system. That cost has gone up by 32 percent in the past six years, Eberhart-Phillips said.
“Don’t tell me that you don’t want to raise taxes. By not doing something about the diabetes problem, your constituents are already paying a higher and higher tax,” he said.
To bring that number down to a local level, Health Care Access spends about $75,000 a year treating diabetes.
“If (diabetes) were to go away, we would have more time to treat everything else, more illness prevention and wellness,” Winfrey said.
Fighting the fat
Find a way to fix the obesity epidemic, and the diabetes problem will disappear, Eberhart-Phillips said.
“The way we are living right now isn’t natural. It isn’t the way we were designed,” he said.
The bodies of people with type 1 diabetes, which occurs in children and young adults, don’t produce any of the insulin necessary for breaking down sugar, starches and other foods into energy.
In type 2 diabetes, which accounts for 90 to 95 percent of all cases, the body doesn’t produce enough insulin or the body doesn’t use it properly. According to the American Diabetes Association, genetics and the environment contribute to developing both types of the disease.
And while family history is one of the strongest risk factors for getting type 2 diabetes, the ADA notes that genetics seem to matter only in people “living a Western lifestyle.”
That Western lifestyle includes eating too much and not exercising enough.
“As we get fatter, we get more diabetes. We know that is a positive link,” said Jen Brull a family medicine physician in the small western Kansas town of Plainville and a member of the Kansas Diabetes Action Council.
If the entire American population could shift its weight downward by 10 to 20 pounds, it would prevent 60 percent of future diabetes cases, Eberhart-Phillips said.
“If we could solve that, if we could get people’s weights back to where they belong, to what is natural and normal for human species … then we will be going a long way to control not only diabetes, but heart disease, stroke, cancer, all the major killers,” he said.
Curbing the surge
The first thing Eberhart-Phillips points to when he talks about the fight against diabetes is the row of fast-food restaurants and big box stores along Lawrence’s Iowa and 23rd streets. It’s what he calls “Diabetes Gulch.”
“That is just like a row of saloons for an alcoholic,” Eberhart-Phillips said. “It is one fast-food place after another. And, how do you get from place to place, but in your car? You never have to expend any energy.”
Solutions for curbing the surge in diabetes go beyond the doctor’s office or the treadmill.
“The decisions that most impact people’s health are made by people who have nothing to do with health, nothing to do with medicine directly,” he said. “It is people who run school systems, it is people who run transportation systems, it is people who plan and design our cities. They are the people who place shopping centers three miles from where anyone can walk to them.”
On the pyramid of what prevention methods work the best, the one with the smallest impact is telling people they need to change their behavior. Creating environments that lead to healthier lifestyles is more effective, Eberhart-Phillips said. That will require getting public health officials involved in local politics.
In fact, this legislative session, two proposals are expected to emerge that will help reduce obesity and, in turn, diabetes.
One would require all national chain restaurants to include on their menus how many calories each dish contains. The other would require schools to replace junk food in vending machines with healthier options.
Educating people about the risks of diabetes is also key, said Brull, who works with the Kansas Diabetes Action Council. That group has created a tool kit that communities can use to better educate people at risk for diabetes.
“The idea is to get enough people aware of the situation so they will look around and say, ‘I don’t want to be a diabetic. I don’t want to lose my feet, because I have diabetes. What can I do now to keep from getting it in the first place?’” Brull said.
And changes are being made here in Lawrence. At the Leo Center, diabetic patients are placed in a program that helps them monitor the disease and make lifestyle changes. The Leo Center also has support groups that share tips on monitoring diabetes, information on healthy foods and medical advice.
“It’s an uphill battle,” Stewart said, “but one we can’t afford not to engage.”