Field Notes

Church-Based Diabetes Education Program
Leads to Healthier Lifestyles Among Latino Adults

Latino adults with diabetes who participated in a church-based education program reported eating less high-fat food and exercising more following a trial intervention program run by researchers from the University of Chicago’s department of medicine.

The Picture Good Health program, based in the city’s South Lawndale/Little Village neighborhood, included an eight-week series of classes led by trained community members. The participants, mostly older Latino women, all had a previous diagnosis of diabetes and were recruited from two Catholic church communities. The results of the study, published April 28 in the Journal of General Internal Medicine, demonstrate the effectiveness of partnering with faith-based organizations to deliver diabetes education in the Latino community.

“People were very pleased with the fact that the program was at the church, that the class leader was someone from the community, and that it was held in a comfortable, familiar place,” says Arshiya Baig, MD, MPH, an assistant professor in the department of medicine at the University of Chicago and lead author of the study.

The project was a collaborative effort with the Little Village Community Advisory Board, made up of leaders from the community who helped recruit participants and organize local resources. During each session, participants discussed their personal experiences with diabetes, how it affected their families, and where they found resources locally to manage the disease. Community members trained by research staff led the discussion, which usually began with participants sharing personal photos that illustrated how diabetes affected their lives, and what they were doing to cope with the challenges.

Six months after the conclusion of the program, participants in the eight-week class reported fewer days of eating high-fat foods and more days of participating in exercise than those who attended a single 90-minute lecture. There were no statistically significant differences in weight, hemoglobin A1c, LDL cholesterol, and blood pressure levels between the two groups at follow-up, but Baig says she suspects those changes would begin to manifest as participants’ healthier diet and exercise habits continued over a longer period of time.

Baig says the Picture Good Health program shows how important it is to provide educational resources for people with diabetes in a comfortable, accessible setting among peers.

“People were sharing very intimate details about their families, their lives, and their struggles with people they’d normally consider strangers. But somehow they felt very comfortable and supported by people who spoke their language, who were of their faith, had a similar diagnosis, and came from a similar upbringing,” she notes. “It normalizes the experience. So if a person is distressed about the cost of medication or the impact on their family and diet, they can speak about it in a comfortable environment. When someone else says, ‘I have that same issue,’ somehow, you feel okay too.”

— Source: University of Chicago Medical Center


Sugar and Carbs, Not Physical Inactivity, Are Behind
Surge in Obesity

It’s time to bust the myth that anyone—and that includes athletes—can outrun a bad diet.
Excess sugar and carbohydrate consumption, not physical inactivity, is behind the surge in obesity, according to experts in an editorial in the British Journal of Sports Medicine published online in April.

Regular exercise is key to staving off serious disease, such as diabetes, heart disease, and dementia, the authors wrote, but calorie-laden diets now generate more ill health than physical inactivity, alcohol, and smoking combined.

The evidence now suggests that up to 40% of those within a normal weight range will nonetheless harbor harmful metabolic abnormalities typically associated with obesity.
But few people realize this, and many wrongly believe that obesity is entirely due to lack of exercise, a perception that’s firmly rooted in corporate marketing, the authors say.

“Celebrity endorsements of sugary drinks and the association of junk food and sport must end,” they state, adding that health clubs and gyms need to set an example by removing the sale of these products from their premises. “The ‘health halo’ legitimization of nutritionally deficient products is both misleading and unscientific,” they wrote.

Public health messaging has unhelpfully focused on maintaining a ‘healthful weight’ through calorie counting, but it’s the source of the calories that matters, they point out. “Sugar calories promote fat storage and hunger. Fat calories induce fullness or satiation,” they wrote. 
The prevalence of diabetes increases 11-fold for every 150 additional sugar calories consumed daily, compared with the equivalent amount of calories consumed as fat, they say.

And the evidence now suggests that carbs aren’t any better, they add. Recent research indicates that cutting down on dietary carbohydrate is the single most effective approach for reducing all of the features of metabolic syndrome and should be the primary strategy for treating diabetes, with benefits occurring even in the absence of weight loss.

Furthermore, other research suggests that rather than carbohydrate loading ahead of intense exercise, athletes would be better off adopting a high-fat, low-carb diet, particularly those who are already insulin resistant.

The food environment needs to be changed so that people automatically make healthful choices, the authors suggest. This “will have far greater impact on population health than counseling or education. The healthful choice must become the easy choice,” they say.

“It’s time to wind back the harms caused by the junk food industry’s public relations machinery. Let’s bust the myth of physical inactivity and obesity. You can’t outrun a bad diet,” they conclude.

— Source: British Journal of Sports Medicine