Diabetes and Obesity: What Are the Choices?

Diabetes and Obesity: What Are the Choices?

Diabetes is becoming an increasingly serious health problem across the United States, and indeed across the world. The majority of cases of diabetes, both in terms of new diagnoses and of current cases, are those of Type II diabetes, which is a condition generally brought on by overweight or obesity and lack of exercise, that prevents an individual's body from being able to metabolize the glucose in food in an efficient and healthy way. Individuals with Type II diabetes (as opposed to individuals with Type I diabetes) can generally be quite successfully treated by losing weight and increasing exercise. Individuals with Type II diabetes can often bring their symptoms and risks under control and even potentially eliminate them through good diet and weight loss.

Given that Type II diabetes can have very serious long-term consequences (including early death due to stroke or heart disease, blindness, and amputation), it is vital that individuals with this condition be well educated about the benefits of weight loss. They also need to be supported in making lifestyle changes that will reduce the high blood sugar levels that mark the disease and that are the mechanism of the dangerous consequences. This paper examines one population in terms of the individuals' knowledge about their condition and what options are open to them in their community in terms of support for changing habits and maintaining those lifestyle changes.

The population chosen for this proposed study is a group of college students ranging in age from 18 to 30. All of them are enrolled at Hostos Community College. I chose this population in part because I had good access to it. But I also chose it because community college students have been documented to be less well informed than are four-year college students about measures that they can take to control and even defeat Type II diabetes. My initial focus for this study is to determine if the students in this survey know whether they were a healthy weight. To determine healthy weight I will use a standard and well-accepted measure: The Body Mass Index (or BMI) measure. This measure is easy to use and understand since it requires an individual to enter only his or her weight and height into a computer application.

Despite the fact that the connection between weight and diabetes (as well as weight and a number of other health factors) is something that each of us should be aware of, given how frequently it is discussed on everything from the backs of cereal boxes to Oprah, I believe that many people are in denial about whether or not they are a healthy weight. Part of the reason for this may well be that because so many Americans are overweight or obese, this state has become the new normal. When people look in the mirror or step on the scale they do not register what they are actually seeing. Rather, they recognize that they look like pretty much everyone else that they know. This is in all likelihood true; however, it does not mitigate the fact that their weight can also be at an unhealthy level. Adult obesity "is associated with reduced quality of life, social stigmatization, and discrimination" (Early Release, 2010).

Over the past decade, obesity has become recognized as a national health threat and a major public health challenge. In 2007 -- 2008, based on measured weights and heights, approximately 72.5 million adults in the United States were obese (CDC, unpublished data, 2010). Obese adults are at increased risk for many serious health conditions, including coronary heart disease, hypertension, stroke, type 2 diabetes, certain types of cancer, and premature death. (Early Release, 2010).

You Can Lead a Student to a Salad Bar & #8230;

The disjuncture between people's self-perception and a realistic assessment of their weight was confirmed last week that nine out of ten students that I randomly approached on campus stated that believed that they were at a "normal" weight, with only one reporting that she was overweight. In fact, after BMI was calculated for each of the individuals, it was determined that the nine who believed themselves to be at a healthy weight were in fact either overweight or obese and the one who believed that she was overweight was in fact at a healthy weight. (Although outside of the scope of this paper, it is important to note that some people, especially some girls and women, have a distorted body image that makes them unable to recognize that they are not overweight and may in fact be underweight.)

College administrators are aware of the problem of rising rates of obesity among the student body and have taken steps to mitigate this problem. The college offers a six-week weight control program twice a year. The last time this program was offered (in the fall of 2010), 6,000 students participated, indicating that they are at least to some extent aware of the importance of a healthy weight. The program covers a wide range of topics, including advice on diet as a life-long series of choices rather than a two-week sprint to fit into a new swimsuit. Students can learn about how to integrate exercise and diet and about the risk factors that exist with both excess weight and inactivity.

The college also has health fairs twice a year where students can get their blood pressure measured for free and get advice on long-term health and health risks. Students who have high blood pressure -- which can be an indicator for a number of possible serious health problems -- are urged to follow up with a doctor for further tests and advice. However, while both the program and the health fairs are a good start, according to Alejandrina Pena, a nurse at Hostos Community College, there is no follow-up to ensure that students connect with the kind of care that they need. Students without health insurance are especially likely to fail to have any follow-up care because of the cost.

Russel Levine, a Wellness Specialist at Hostos Community College, also stated in an interview that there is no follow up to the programs or health fairs. He also noted one of the major problems with long-term health issues: Individuals have to have information and appropriate support, but they also have to be motivated to take care of themselves, something that can be very difficult to do. Levine said that in offering a comprehensive program to guide and support students through a personal journey to better health and weight management, the college is attempting to provide each student with the ability to develop a life-long healthy relationship with food, physical activity, and weight in an environment that helps students achieve their academic goals. After that, it is up to the students to take the necessary actions to begin to adopt the healthy behaviors that they will need for the rest of their lives.

Comparison to Other Colleges

The fact that Hostos Community College students tend to be overweight or obese as well as the fact that they tend to deny the seriousness of excess weight (as well as other indices such as raised blood sugar or elevated blood pressure) should not be surprising. For one thing, this is probably generally true of all Americans, but it is more especially true of students at two-year college populations (at least vis-a-vis students at four-year colleges).

The college years are especially important for individuals in terms of establishing life-time healthy eating and exercise habits, as "During the transition to adulthood, independence and autonomy increases, and long-term diet and physical activity patterns may be established" (Laska, et al., 2011). Community college student populations have been studied far less than students at four-year colleges (where professors as well as graduate students often use undergraduates as research subjects). The research done at four-year colleges is limited in relevance and generalizibility to two-year colleges since the student bodies at the latter are "more racially diverse and economically disadvantaged groups than other postsecondary institutions" (Laska et al., 2011). This study surveyed about 16,000 students from both two-year and four-year colleges to determine student weight and eating and exercise habits.

Overall, this study found that while the male students at the two types of colleges were relatively similar to each other, the female students differed significantly.

Unadjusted analyses [in which race and ethnicity were not segregated] indicated that students enrolled in 2-year colleges, particularly females, had a higher prevalence of overweight/obesity, lower levels of physical activity, more television viewing, higher intakes of soda, fast food, and diet pills compared to students attending 4-year colleges (P < 0.05). Females attending 4-year colleges were more likely to engage in certain unhealthy weight control behaviors (taking diet pills, binge eating, self-induced vomiting) compared to females attending 2-year institutions. Among male students there were fewer differences between 2-year and 4-year colleges. Controlling for sociodemographic factors (e.g., race/ethnicity, age), most disparities in prevalence estimates remained, though many were attenuated. Overall, few young adults engage in weight-related behaviors consistent with national recommendations. (Laska et al., 2011)

Both ignorance and laziness are often cited as the reasons that people are overweight or obese: Perhaps the most common cultural narrative about overweight people is that they are heavier than would be healthiest for them because they are too lazy to exercise.

However, the students surveyed by Laska et al. As well as the students at Hostos Community College are neither uneducated nor lazy. Indeed, it is more how busy they are than how lazy they are that seems to be at the root of weight problems for many of them.

Proposed Research

The above cited research along with preliminary research that I have gathered about students from Hostos Community College suggest the direction that a future comprehensive study of the student body would take. One of the key aspects of two-year college students that sets them apart in a significant way from four-year college students and that makes them more like non-students in many ways is that they have multiple and often conflicting obligations. Two-year college students are also usually employed and many have children as well as other family obligations.

These pressures on their time often send them to fast-food outlets multiple times each week, where the foods that they have access to are almost all high in fat and sugar (as well as salt). These students do not think that the food they are buying for themselves and their family members is healthy. What they know is that it seems to be the only option that is reasonably open to them (Van Kim et al., 2010).

Thus a key element of the survey that would be randomly administered to the students in the study that I am proposing is how many hours a week students spend on different activities, including taking care of family members, commuting, working, and studying. This information would be correlated with BMI measures for the students to determine if there is a significant correlation between the number of hours that students spend in work and in family obligations and their BMI.