Prevention is key in ‘Diabetesville’

A few years ago, filmmaker Mike Seringer came to the Rio Grande Valley to make a documentary about our alarming rate of diabetes — highest in the nation.

The premise of the film, Diabetesville, USA (, is that the Valley is a preview of what the entire U.S. will look like in 2050.

We arrived early at the alarming statistic that puts over half our adult population on the Diabetes spectrum (pre-diabetic to diabetic), and this is what the rest of the country has to look forward to if major changes are not made to alter environment, policies and lifestyles.

Unfortunately, the topic is interesting because it is tragic.

Most Rio Grande Valley residents know someone who injects insulin, has lost a limb, or spends hours a week hooked up to machines at one of the dozens of dialysis centers in our community.

The healthcare industry continues to thrive and grow locally because we have such incredibly high rates of chronic disease, fueled by the fact that over 80% of us are overweight and obese.

But just having more doctors, hospitals, pharmacies and dialysis centers will not improve this grim statistic.

In fact, people do not improve their health or change their lifestyle while sitting in a clinic or hospital — they make changes (or don’t) in their daily lives where they live, work, worship and play.

Many people have lost relatively young family members to complications of diabetes.

In fact, it is so much a part of our lives here in the Valley, that we hardly want to go watch a movie about it. We’d rather hear about drug wars and murder, but the reality is that while the violence in Mexico and along the border is also tragic, this preventable disease kills and maims many more of our neighbors and family members on both sides of the border than are harmed by drug cartels.

In fact, a third of the adult population in Cameron County has diabetes, many more have pre-diabetes, which is really diabetes just waiting to happen. One minute all seems well and the next thing you know your body is being ravaged by a disease that impacts most of your organs.

And when I say maimed, I mean it. Diabetes does a number on most of the body significantly increasing the risk for kidney and liver disease, heart attack, blindness, limb amputations, memory loss, depression and more.

While the percent of our family members and neighbors diagnosed with diabetes is alarming enough, even more staggering is that 50 percent of our locals who have diabetes don’t know they have it. By the time they develop symptoms, the disease has worn down the body so complications are inevitable.

Worse yet, a larger segment of our community is pre-diabetic, many of them young people, and unless they take steps to improve their health, they are on the road to full-blown diabetes. The Center for Science in the Public Interest publication Nutrition Action describes people actually diagnosed with diabetes as just the “tip of the iceberg” (Nutrition Action July/August 2014).

Dr. Susan Fisher-Hoch, a local researcher at the UTHealth, School of Public Health in Brownsville, leads the Cameron County Cohort, a randomized longitudinal study which provides a precise snapshot of our population, with over 4,000 subjects followed over a decade.

“Diabetes is not a disease you either have or you don’t. It is a spectrum of insulin resistance. The medical community has selected a level at which a diagnosis of diabetes is made. But by the time your blood sugar reaches that point, much damage has already been done. We really need to be focused on the population that is pre-diabetic, because that is where we can be most effective — before serious damage is done.”

In other words, we need to focus on the massive iceberg under the surface, not just the tip. With lifestyle change and weight loss, Fisher-Hoch explains, most pre-diabetics can postpone and often even prevent reaching that point.

“Reasonable weight loss and dietary changes (not drastic) dramatically reduce progression. In other words ‘Get it before it gets you!’ needs to be the message.”

And what drives such high diabetes rates locally and nationally? There are some genetic factors, but the main culprit is our weight gain, especially around our middle. The body is resistant to the hormone insulin, which acts like a key to allow sugar to enter the cells, where it can be burned for fuel. But when we have an oversized waist the key cannot open the lock.

To compensate for this resistance to insulin, the cells of the pancreas pump out more insulin. It works for a while, but eventually the cells wear out and the pancreas can’t keep up. That’s when pre-diabetes become diabetes and much of the damage is already done.

The issue locally is complicated by the fact that so many people in our community don’t have access to health insurance or a doctor, since over half of adults in the Valley are uninsured. Healthy lifestyle choices are not as accessible to our majority low-income population as they are in other regions either, partly because local leaders have not prioritized the design of healthy cities, but also because resources are limited.

That is why many organizations are coming together to hit this problem hard from all angles. We need media, schools, churches, cities, businesses, planners and everyone to create more opportunities for people in our community to make healthier choices. A lot has been done over the last decade and we are starting to see improvements in, for example, the time spent doing physical activity.

There are even some initial statistics that show a positive trend for Cameron County as compared to its neighboring counties. This is at least partly because of the effort taken to focus leadership and initiatives on healthy lifestyle and weight-loss.

After all it should be a priority of our policy-makers and leaders to our help protect our residents from preventable, costly chronic disease, disability and loss of employment and income, and high cost of treating the disease due to complications from diabetes, and even death.

While people with diabetes need treatment and access to care, we also need to focus on the back end of the disease since that’s when lifestyle changes can make such a difference.

After all, wouldn’t it be great if someday a filmmaker makes a documentary about the Valley called “Healthyville, USA”? That can happen when we work together to promote a healthy environment, because Tu Salud ¡Si Cuenta! (Your Health Matters!)