Obesity, diabetes epidemics continue to grow in California, study finds

Both conditions -- which are related to each other as well as to heart disease -- increased significantly in just six years, with the prevalence of diabetes alone jumping nearly 26 percent between 2001 and 2007.

The "epidemic" of obesity and diabetes leaves no racial, ethnic, economic or geographic segment of the state unscathed, according to the researchers. Although American Indians, African Americans and Latinos are particularly affected by both obesity and diabetes, these conditions increased among all racial and ethnic groups between 2001 and 2007.

Similarly, while both conditions disproportionately affect the poorest Californians, there were upward trends in prevalence among all income groups during the same time period. California's youth are also affected: More than a quarter of California adolescents -- some 970,000 children -- are obese or overweight.

"When so many people of different ages, income and educational levels, and cultural backgrounds are struggling with obesity and diabetes, it suggests that 'going on a diet' is not enough," said research co-author Dr. Allison Diamant, a faculty associate with the center and an associate adjunct professor of general internal medicine and health services research. "We need to take a hard look at the environmental and structural factors that contribute to these conditions."

The study specifically recommends that policymakers and others seek ways to increase access to recreational facilities and parks, as well as promote policies that encourage farmers markets and improve access to food outlets that stock fresh fruits and vegetables and other healthy fare.

The consequences of failure are severe. California is falling far short of the targets for obesity and diabetes set by Healthy People 2010, a national health-promotion and disease-prevention plan. For example, obesity among California adolescents is more than twice as high as the national target of 5.0 percent, while the rate of diabetes among California adults is more than three times the federal goal of 2.5 percent of the population.

"It is a travesty that beer and Flaming Hot Cheetos are more readily available than an apple in low-income communities across the state," said Dr. Robert K. Ross, president and CEO of The California Endowment, which supported the study. "Local governments must support community efforts to bring in healthy food to these communities and expand opportunities for children and families to engage in physical activity by cleaning up parks and improving community safety."

In California, the total annual cost of diabetes is estimated to be $24 billion, with $17 billion spent on direct medical care and $7 billion on indirect costs associated with the disease. The cost of obesity to families, employers, the health care industry and the government is equally steep: $21 billion. If obesity and diabetes continue to affect more and more of the population, the associated costs will continue to grow.

Although there are a number of factors associated with diabetes and obesity, ranging from genetics to individual behaviors, the composition and structure of neighborhoods and social environments have been increasingly implicated as impediments to maintaining a healthy lifestyle. Both physical activity and healthy eating are important for preventing and reducing obesity and diabetes.

California has enacted reforms to encourage healthy eating, including requiring chain restaurants to display calorie information and prohibiting the sale of soda and other sweetened beverages on K-12 school campuses.

However, the study authors conclude that more needs to be done to promote environments that promote regular exercise and healthy eating.

Other study findings:

• Hardest-hit counties -- Obesity prevalence was highest in Imperial (39.6 percent), Merced (34.3 percent) and Tulare (31.1 percent) counties, while diabetes prevalence was highest in Tulare (12.1 percent) and Fresno (10.9 percent). Regionally, the San Joaquin Valley had the highest prevalence of both obesity (30.0 percent) and diabetes (9.4 percent). Los Angeles County, due to the size of its population, had by far the most obese residents (1.7 million) and the most residents diagnosed with diabetes (642,000).
• Low-income adults at risk -- Adults living below the poverty line had a significantly higher prevalence of obesity (27.7 percent) than higher-income adults (19.6 percent). Similarly, diabetes was more prevalent among the poorest adults -- those living below 200 percent of the federal poverty level.
• Education a factor -- The prevalence of obesity was nearly twice as high among adults with no more than an eighth-grade education (30.3 percent) as among those who graduated from college (14.9 percent). Diabetes prevalence was three times as high among adults with no high school education (14.8 percent) as among those who graduated from college (5.1 percent).

The study is based on data from the 2001, 2003, 2005 and 2007 California Health Interview Survey (CHIS), the nation's largest state health survey.