Susan Cooper

Trying to maintain a healthy diet in Dixie is no picnic.

“You look on every corner: fried chicken, fried catfish, fried pickles — if there’s something you can fry, they’re gonna fry it,” said Missionary Ridge resident Ellie Sullivan, 56, who grew up in Mississippi and was diagnosed with diabetes two years ago. “Southern people just want to hang onto that fried food heritage, and it’s killing us.”

Staff Photo by Allison Kwesell Jackie Rogers, MS, RD, a certified diabetes educator, teaches the Memorial Diabetes and Nutrition Center's nutrition class. Patients are encouraged to come to the class several times as continuing education about their health.

New federal statistics on the skyrocketing rate of diabetes in the South underline the roadblocks to healthy living in states such as Tennessee and Georgia, public health advocates say.

Fueled by rising obesity rates, the incidence of diabetes nearly has doubled across the nation since the late 1990s, and the South is being hit the hardest, according to the most recent figures from the U.S. Centers for Disease Control and Prevention.

Nationwide, rates increased from 4.8 per 1,000 people from 1995 to 1997 to 9.1 per 1,000 from 2005 to 2007, according to a survey published in the CDC’s Morbidity and Mortality Weekly Report.

The highest rates of new diabetes cases were found in Tennessee, Alabama, Georgia, South Carolina and West Virginia.

The new statistics are “frightening, but they’re not surprising,” said Tennessee Health Commissioner Susan Cooper. In Tennessee, adult obesity rates, linked to type-2 diabetes, now surpass 30 percent, she said. And there’s no quick fix, she said.

“We didn’t get overweight overnight, and we’re not gonna make substantial change on a population basis overnight,” she said.

COST CONCERNS

Throughout Tennessee and Georgia, health advocates and public health officials are scrambling to get a handle on an epidemic costing billions annually and with serious consequences for patients’ quality of life.

Diabetes can lead to blindness, limb amputation and kidney failure, which compels patients to rely on dialysis to survive, said Dr. Howard McMahan, president of the Georgia Academy of Family Physicians. All of these complications, aside from the impact on quality of life, place a huge burden on health care expenses, he said.

The nation’s total annual cost of diabetes in 2007 was an estimated $174 billion, including $58 billion for chronic diabetes-related complications, according to the American Diabetes Association.

“I can envision, within 10 years time, 40 percent of the health care dollar being spent on diabetic complications,” Dr. McMahan said.

In Tennessee, annual diabetes costs in 2007 were an estimated $4.5 billion, according to a report by Dr. William Rowley, chief operating officer at the Virginia-based Institute for Alternative Futures, a nonprofit research organization.

PREVENTION EFFORTS

The vast majority of U.S. cases of diabetes — about 90 to 95 percent — are type-2 diabetes, for which obesity and inactivity are risk factors.

But type-2 diabetes, previously called “adult-onset diabetes,” is affecting younger and younger people, said John Bilderback, program manager for Step ONE, a Hamilton County campaign to fight obesity.

“You’re basically talking about kids, by the time they get to 10 to 13 years of age, (who) just stop being active, and we’ve got to learn how to bridge that gap between childhood and when they move into adolescence,” he said.

Locally, health advocates are tackling obesity and overweight rates by encouraging healthy activity through the Step ONE program.

The Get Fit Tennessee awareness initiative is a Web site that provides free diet and exercise journals, as well as strategies to monitor progress toward fitness goals and create fitness challenges for friends and family, Ms. Cooper said.

At the Southside Dodson Avenue Community Health Centers, more than 800 patients are diabetic and, since 2001, health professionals there have focused on educating them on how to manage their condition and provided financial assistance for medical supplies and treatments, said Helen Pinkerton, disease management/wellness initiatives coordinator for the centers.

In Georgia, where in the last decade diabetes rates increased from 6.2 to 11.2 per 1,000 people, health officials are encouraging state employees to stay on top of their diabetes maintenance. Those in qualifying insurance plans who participate and comply with such maintenance receive free diabetes drugs, said Nancy Goldstein, division chief of Georgia’s state health benefit plan, part of the Georgia Department of Community Health.

Considering the national economic crisis under way, “the last thing we want is people to scrimp on their medications, especially with a disease where it is so critical to be sure that they’re managing their insulin levels,” she said. “Ultimately down the road, if employees’ health is better, that translates into cost savings for the state.”

For Ms. Sullivan, a diabetes education class at Memorial Hospital shocked her into compliance with her diabetes maintenance drugs. In past years, she’d regularly miss doses, she said.

“Oh my goodness, what a difference (the class) has made,” said Ms. Sullivan, who now also watches her diet and swims three times a week. “I don’t know if I was in denial, but ... being in that class gave me a wake-up call.”

CHALLENGES IN THE SCHOOLS

Trying to influence kids’ eating habits at a young age, Tennessee schools have been commended for improvements in nutritional standards for food and drinks sold on school grounds in cafeterias, vending machines and school stores, Ms. Cooper said.

In Hamilton County, school officials have added more fruits and vegetables to cafeterias and reduced the amount of desserts offered, said Carolyn Childs, school nutrition director. Officials soon hope to have carbohydrate counts on cafeteria offerings, she said.

Even still, in Hamilton County, as more young children are diagnosed with diabetes, district school nurses are confronting a rising tide of students who need help with daily maintenance of their conditions, said Sheryl Rogers, director of school health programs for Hamilton County Schools. The growing demand is stretching school nurses who already are responsible for more than one school campus, she said.

Over the past three school years, the number of students that school nurses regularly helped with their diabetes care grew from 93 to 120 to 191 this year, she said. And they’re getting younger, she said, with diabetic children in elementary schools becoming “the norm.”

“It’s disturbing that they get such an illness at such a young age. Some of them are just learning how to read,” she said. “We (must) train them how to manage their diabetes on top of everything else.”