Diabetes Prevention Programs: Not Working

Diabetes Prevention Programs: Not Working

Tribal Program Troubles

File:Rosebud ambulance.JPG

Photo by B. Beauvais: Wikimedia http://commons.wikimedia.org/wiki/File:Rosebud_ambulance.JPG

I spoke to the director or a tribal diabetes prevention program. They are expanding, adding a mobile facility and doubling the size of their exercise facilities[1]. They have two government grants that have been running for about 11 years, the Initiative Grant and the Community Grant, as she called them. They spend about $1 million each year. They teach about healthy lifestyles and eating. One grandmother who had received some of the teaching wanted “to ban the Frito-Lay man from the rez.”

I noted that there seems to be scant evidence that food selection and cooking education programs in WIC and SNAP in non-Indian populations are changing habits. I suggested that her program’s cooking education efforts may not be changing habits. She said, “I agree.”

I said, “In Montana, food stamps don’t buy many cooking ingredients; people seem to want instant tear-open consumables.”

She agreed that the same thing occurs in her community. “They buy highly processed, packaged food.”

If the rate of uptake of diabetes on her reservation is similar to overall trends among
American Indians[2], the $1 million in spending is completely ineffective. The epidemic rages in spite of programmatic spending. Indian youth 10-19 are developing diabetes at a rate 8.6 times higher than non-Hispanic whites. $11 million spent for nothing.

The director admitted that much eating happens at “grease pits,” the reservation’s substitute for fast food franchisees. Residents “eat fry bread at almost every event.” (I drove to the back of the Crow Agency Headstart program’s building one day about lunchtime. Two portly women were cooking fry bread on a deck behind the facility, obviously for serving to the kids. A new government diabetes treatment facility a few blocks away was getting the finishing touches. Its future customers were being readied in Headstart.)

The director said, “The lifestyle is hard on people. There’s a lack of resources. Running and walking is dangerous because of so many stray dogs.”

I asked if the rise of gangs and unruly young men is a danger that keeps people from walking in the open. She confirmed it.

She said, “Stores open at midnight on the 9th, food stamp night. People line up. Stores stock up on pizza and ready-to-eat items.” (The government replenishes food stamp credit on electronic benefit transfer-EBT- cards at midnight on the 9th.)

It seems that the tribal program was not effective at preventing diabetes, only at pulling down federal funds.

Montana Program Troubles

Is Montana’s Diabetes Prevention more successful? It is successful at spending money and hiring employees. It has seven full-time equivalent staffers, some of them half-time. It’s been running about 4 years and spends about $600,000 each year. Cost per participant is $881. Over four years[3], 2,724 participants lost on average 12 pounds each, 32,688 pounds. For $2.4 million spending, that is $73.42 per pound lost. Weight loss recidivism[4] is 94%. Government spending per pound kept off is $1,223.66. For whom is this effective?

It seems diabetes prevention programs have a dismal record. The desired results are non-existent.

http://www.singingtotheplants.com/2009/08/gift-of-diabetes/ An Indian filmmaker documents his own diabetes.

[1] She said the exercise center was well-used.

[2]  Among children and adolescents aged 10–19 years with type 2 diabetes, the estimated rate of new cases was 3.7 per 100,000 per year for non-Hispanic whites; 19.0 per 100,000 per year for non-Hispanic blacks; 11.6 per 100,000 per year for Hispanics; 12.1 per 100,000 per year for Asians/Pacific Islanders; and 32.0 per 100,000 per year for American Indians. http://www.cdc.gov/diabetes/pubs/figuretext11.htm#fig3


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