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Sugar Shock

news_obeaseSanta Cruz County has high rates of obesity, diabetes among children and adults

Several years ago, a close friend of mine discovered that she had diabetes. In the weeks leading up to her diagnosis, it became increasingly clear that something was very wrong: she was achy, thirsty, and so bone-tired that she slept for most of every day and still felt fatigued. The day she was diagnosed, she came home lugging a huge garbage bag filled with medical supplies and pamphlets the doctor had given her to help figure out her new lifestyle. It was, to put it mildly, a daunting task. It took her years to fully learn the intricacies of managing her insulin levels and her nutritional needs.

This is a scenario that Raquel Ramirez Ruiz knows all too well. Ruiz is the Director of the Diabetes Health Center (DHC), an outpatient program in Watsonville that teaches prevention and self-management for people who are either living with diabetes or are at high risk for the disease. She herself is one of the latter.“Obesity runs in my family,” she explains. “My dad has type-2 diabetes and has struggled to manage it.” She encouraged him to make an appointment with Martha Quintana, one of the registered nurses and certified diabetes educators at the DHC. “He left motivated to manage his diabetes,” she says. “This is the first time since he was diagnosed that I have witnessed him make better food choices.”


55.8 percent of adults in Santa Cruz County were classified as overweight or obese based on their BMI, up from 50.3 in 2007.
This includes about 50.3 percent of Caucasians and 71.6 percent of Latinos—a huge jump from just 51.9 percent of Latinos in 2007.

According to the National Institute of Health,  obesity, which is defined as having a Body Mass Index (BMI) higher than 30, may be linked to developing diabetes; an estimated 80 percent of people with type-2 diabetes are overweight or obese. The Santa Cruz County Community Assessment Project (CAP), which is sponsored by the United Way of Santa Cruz County, released its 15th annual report this month. It reports that in 2009, 55.8 percent of adults in the county were classified as overweight or obese based on their BMI, up from 50.3 in 2007. This includes about 50.3 percent of Caucasians and 71.6 percent of Latinos—a huge jump from just 51.9 percent of Latinos in 2007. Some parts of the county are disproportionately impacted: 22 percent of Watsonville/Pajaro Valley residents are obese, compared with just 12 percent of people in other parts of Santa Cruz County.

But Professor Julie Guthman, an associate professor in community studies at UCSC who has written extensively on agriculture, food movements and obesity, warns against conflating the categories of “overweight” and “obese”—she says that though they are often linked together in public health studies, they are not exactly the same thing. “Obese and overweight are overlapping categories—over 25 is overweight, over 30 is obese,” she says.  “A lot of studies from the Center for Disease Control are showing that, for adults, groups with a 25 to 30 BMI have no higher mortality than a thinner group. This isn’t necessarily true for children, but for adults, overweight is actually protective. It doesn’t put you at increased risk for anything.”

Her research has also led her to conclude that while there is a relationship between obesity and type-2 diabetes, it is still far from clear what it is. “There is obviously an association between diabetes and fat,” she says. “Fat means that the glucose isn’t being transformed into energy, it’s being stored as fat. But on some level, they just really don’t know yet which one causes the other.”

Guthman also responded to the CAP statistic that 12 percent of those surveyed this year reported having received diagnoses of either diabetes or pre-diabetes at some point in their lives. She points out that putting diabetes and pre-diabetes into the same category may be misleading. “Pre-diabetes means you have blood glucose levels over a certain number,” she says. “But that doesn’t mean you have diabetes. That means you have higher blood sugar circulating around. That may or may not manifest as diabetes.”

As of 2007, about 7.3 percent of adults ages 18 and older have been diagnosed with diabetes in the county. Nearly 90 percent of those cases were type-2, consistent with figures statewide, where about 87 percent of diagnosed diabetes cases are type-2. The Watsonville/Pajaro Valley area also has higher rates than other parts of the county: about 14 percent of people have diabetes, compared with around 7 percent in the City of Santa Cruz.

For her part, Director Ruiz is most worried about childhood obesity and its implications. “In the past couple of years we have seen a big increase in children referred to us for obesity-related complications,” she says. “At the moment, 25 percent of our clients are children under 20. Most of these children have been referred for obesity-related diagnoses. Our youngest type-2 patient was eight years old.”

In 2008, Santa Cruz County ranked 40th (one being the best) out of California’s 66 counties for overweight children aged less than five years. In that year, 25 percent of children aged five to 19 in Santa Cruz County were overweight or obese, and 15 percent of children under five years old. Here, too, Watsonville is hit harder: 36 percent of Pajaro Valley Unified School District’s fifth, seventh, and ninth-graders are classified as being overweight or obese, compared to 24 percent of Santa Cruz’s fifth, seventh, and ninth-graders.

The issue of childhood obesity also affects Ruiz on a personal level.  “My 10-year-old nephew is a patient of Danielle Cook, our registered dietitian,” she says. “He’s seeing her for medical nutrition therapy due to obesity-related complications. She encouraged him to participate in and commit to the 52-10 campaign.” Spearheaded by Go for Health!, a county-sponsored collaborative led by the United Way, 52-10 seeks to remind county residents to eat five servings of fruits and vegetables a day, to spend no more than two hours in front of a screen, to get one hour of physical activity, and to drink zero sodas or sugary beverages.

Although nearly 95 percent of residents CAP surveyed this year didn’t know anything about the campaign, Ruiz is confident that, with time, it will help create positive change for Santa Cruz’s younger residents. Her nephew, she reports, is already seeing a difference. “Since his prevention visit, he’s making better food choices and is more active,” she says.

There’s no question that Ruiz and her staff have their work cut out for them going forward. “This past year we were so impacted we had a waiting list of eight to 10 weeks,” she says. But Ruiz hopes that parents, teachers and healthcare providers will become more involved in stressing healthy lifestyle choices for children. Prevention, she argues, is infinitely preferable to trying to do damage control after the fact; her hope is to instill healthy eating and exercise habits in children while Santa Cruz residents are young. “The prevention message is powerful,” she says. “If we can help prevent one person every day from making risky choices or unhealthy choices, then we’re doing our job.”

In November, the United Way named Ruiz as one of their Community Heroes for 2009. She received her honors specifically for the goal of reducing childhood obesity in Santa Cruz County by 5 percent in 2010. “This goal falls on the community at large,” she says. “This is not going to be accomplished by one single program. It is going to need strength and dedication from all of us.”

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