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County health tackles diabetes through obesity prevention

POSTED July 10, 2012 11:52 p.m.

Last year, county health officials reported that most chronic diseases are claiming fewer lives in Stanislaus County, but the diabetes mortality rate remained alarmingly high.

One year after that pronouncement, a nascent countywide effort to reduce obesity and diabetes mortality rates has already made significant progress.

The initial disconnect between other chronic diseases and diabetes can be pegged, in large part, to growing obesity rates, according to the county health department. As those rates have increased adult onset diabetes cases, caused by obesity, have too risen.

“Frankly, it’s become a global epidemic,” said Dr. John Walker, Stanislaus County public health officer.

Where medical advances led to notable improvements in most mortality rates – cardiovascular mortality down 27.6 percent, stroke mortality down 25.7 percent, cancer mortality down 9.5 percent, and overall mortality down 10.2 percent – no improvement was made in diabetes mortality, either within Stanislaus County or the State of California, due to the obesity epidemic.

From 2001 to 2009, Stanislaus County’s self-reported overweight and obese population grew from 45 to 58 percent.  And Stanislaus County ranked 47th out of 58 California counties in diabetes death rate, from 2008 to 2010.

“I’m always astounded by the facts,” said county Supervisor Vito Chiesa. “It’s pretty alarming.”

The findings led to the 2011 establishment of an Obesity and Diabetes Strategic Group, a three-year initiative dedicated to lowering diabetes mortality rates.

The group has adopted a comprehensive prevention-focused approach, oftentimes underused in medicine. But when dealing with a disease caused by obesity, the group found preventing obesity could be the most effective tool.

Stanislaus County Medical Director Dr. Del Morris compared the traditional treatment-focused method to an airline which inspected its planes only after crashes, rather than before every flight.

The new prevention program looks to treat health from a system-wide approach, rather than department-centric previous strategy. The “Spectrum of Prevention” framework calls on county health to teach individuals and communities to lead healthier lives, but it goes farther, too.

“Prevention is more than just education,” said Elaine Emery, program manager at the Stanislaus County Health Services Agency. “It's a lot more than that.”

Prevention could see the agency convince businesses to encourage workers to walk during breaks, or bring in healthy snacks for working meals. It could involve lobbying the state legislature to only define healthy options as valid food choices for school cafeterias. Or it could see a change in planning priorities, creating more walkable communities.

It’s an uphill struggle to change the nutritional mindset of the region, as Stanislaus County offers more than five times as many unhealthy places to eat as healthy – a measure strongly linked with obesity and diabetes. But already, some improvements are being seen.

A University of California, Los Angeles Center for Health Policy Research study identified a 2.1 percent decrease in obesity among Stanislaus County 5th, 7th and 9th graders. Researchers said the decline was related to school system policies which promote healthy eating and living.

A new 2012 California County Health Profile also shows that mortality rates for diabetes in Stanislaus County actually declined from 2008 to 2010, down 10.1 percent.

The work isn’t done. Over the next year, the group intends to focus on several new projects to address the issue, chief among them a new nutrition education program for food stamp recipients.

But for now, indicators seem to be moving in the right direction.

“I think that we are making a difference,” Walker said.

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