Address to the Texas Academy of Physician Assistants
Sen. Uresti's Address to the Texas Academy of Physician Assistants
Hyatt Hill Country Resort in San Antonio
Saturday, Feb. 19, 2011
Texas Public Health Crisis:
Diabetes and Obesity 2011 and Beyond
Good morning everyone and thank you for inviting me here today. I always enjoy visiting with health care professionals… people who make a real difference in the lives of others.
Now, perhaps I shouldn't say that doctors would be lost without you… but… I've already said it. Just look at what you do. You conduct physical exams, diagnose and treat illnesses, order tests and interpret results. You counsel patients on preventive health and even help perform surgery.
All that… and no golf and no lake house! And here you are giving up a Saturday. I salute you for that… and I don't consider it a sacrifice to be spending my Saturday with you.
But while we're here, I hope that other people are doing what they're supposed to on Saturdays… especially with the warm weather we've been enjoying.
It's a day to jog or walk, to bike or hike, shoot a few baskets… anything that gets you up and out… and keeps you moving.
Now I mention this for a reason… because of the very serious problems we're addressing today… diabetes and obesity. As you know, obesity is no longer just a condition. It is a disease. And like diabetes… it has a genetic component.
But there is another component that's perhaps more important… one that must be addressed to confront this growing epidemic. Obesity and diabetes are lifestyle diseases… acquired through poor diets and lack of exercise.
So for many people, they are diseases of excess and lethargy. That fact provides us with a battle plan. But before we talk about how to attack the problem, let's look at how big it is. You may be aware of some of these numbers… but they bear repeating.
One out of every ten adult Texans has been diagnosed with diabetes. That's 1.7 million people over the age of 18 in our state alone.
Diabetes is the sixth leading cause of death in the United States… and the fifth-leading cause among African-Americans and Hispanics. One out of every 16 women in the United States who give birth has diabetes… increasing the risk of miscarriage or preterm delivery.
According to a recent report by Comptroller Susan Combs, the obesity crisis in Texas is costing businesses $9.5 billion annually… and that could climb to $32.5 billion by 2030.
Nationally… according to a Centers for Disease Control report released last month… almost 26 million Americans have diabetes… and another 79 million adults have pre-diabetes.
The CDC's National Diabetes Fact Sheet for 2011 says the disease affects 8.3 percent of all Americans… and 11.3 percent of those age 20 and older. About 7 million Americans have diabetes and don't even know it.
Ann Albright‚ director of the CDC's Division of Diabetes Translation, called these numbers "distressing." They show how important it is to prevent type 2 diabetes… and to help those who've already been diagnosed manage the disease.
These numbers are distressing. They are downright scary. And… believe it or not… they could get worse.
According to a new analysis by the Center for Health Reform and Modernization… more than half of all Americans could have diabetes or pre-diabetes by 2020 if we don't make significant changes in our lifestyles and attitudes.
Think about that. More than half… just nine years away. The report says that diabetes and pre-diabetes will account for about 10 percent of total healthcare spending by the end of the decade… almost $500 billion annually.
The cumulative cost to our health care system and economy, the researchers say, will reach $3.35 trillion by the end of this decade. Yes, you heard me right. I said trillion.
Now this study… aptly called "The United States of Diabetes: Challenges and Opportunities in the Decade Ahead" … does offer some solutions that will improve health and life expectancy… while saving about $250 billion over the next 10 years.
How do we do that? We focus on obesity… create early intervention programs to prevent pre-diabetes… institute stronger medication programs… and educate Americans on lifestyle changes to prevent or control diabetes.
There's that word again… lifestyle. Some of this we already know… the importance of a balanced diet, smaller food portions, and exercise.
And scientists are constantly churning out studies that suggest small, incremental changes can help in this fight.
For example, Harvard researchers found that formula-fed infants who start on solid foods before the age of four months have a higher risk of obesity by three years… compared to those who start solid foods later.
The Feb. 8 issue of the Journal of the American College of Cardiology reports that for severely obese people… gastric bypass surgery may not only lead to weight loss… but could help overly stressed hearts return to more normal function and appearance.
The U.S. Agriculture and Health and Human Services departments are calling on Americans age 51 and older… and all African Americans and anyone with hypertension‚ diabetes‚ or chronic kidney disease… to reduce their daily salt intake.
Reducing salt will make us healthier… and small steps like that can translate into real progress.
And speaking of small steps… the Journal BMJ reported last month that walking not only burns more calories… it can also lower the risk for diabetes. Just walking!
In this study, researchers provided pedometers to nearly 600 adults to measure the steps they took over two consecutive days for five years.
Those who walked the most after five years not only had a lower body–mass index… but also better insulin sensitivity.
I kind of like these next two. The journal Diabetes recently reported that a moderate amount of alcohol may help lower the risk of type 2 diabetes in men. The study followed more than 38‚000 men without diabetes who were involved in the Health Professionals Follow–Up study.
After four years‚ those who were light drinkers at the start of the study but became consistent moderate drinkers significantly lowered their diabetes risk… compared to light drinkers.
In December, researchers at Loma Linda University reported that people who eat an almond-rich diet have increased insulin sensitivity and lower levels of LDL cholesterol… both risk factors for type 2 diabetes.
These last two studies have spurred a real life-style change for me… based on my new diet of Chivas Regal and smoked almonds. I'm thinking of writing a book. But I must confess… this diet make it hard to take the 10,000 steps per day that the BMJ Journal calls for!
But seriously, what can we do? Better yet, what can you do?
As physician assistants, you can do a lot. You see people up close and personal every day. You're involved in their diagnosis and treatment. They trust you… and that puts you in a position to provide council and advice.
You can stress that despite the amazing technological and scientific advances we've made in treating disease… the best cure is still prevention.
Scientists have developed a new type 2 diabetes prevention program that involves reasonable weight loss and other lifestyle adjustments… based on research by the National Institutes of Health and the CDC.
It has demonstrated that improved exercise and other habits… with about 7 percent weight loss‚ can help people with pre–diabetes delay or even prevent the disease.
That is need-to-know information for the people you see each day… particularly those who are obviously at high risk.
Diet and exercise. That is your mantra. Obesity and diabetes can be prevented. As a nation, the alternative is unacceptable. Type 2 diabetes can lead to blindness, kidney failure, heart disease and death. With just a few lifestyle modifications… all of that is avoidable.
Now what can I do? The state Legislature has an opportunity to attack diabetes and obesity on a broad front. For example, when my good friend Jaime Capelo was in the Texas House, he got soft drinks and high-calorie foods banned from our school cafeterias.
Jaime, thank you for that, and thank you for being with us today. Too bad that policy wasn't in place when you were in school!
There are a number of initiatives that are being pushed in the current session, and I'd like to mention a few of them today. By the way, all of these are supported by the Partnership for a Healthy Texas, a coalition of some 22 organizations that has set out to identify and support policies to attack the obesity epidemic.
Now, how many of these initiatives will actually get passed? Those last few, in particular, will be very difficult because of the state's budget deficit. A fiscal note in this session amounts to a kiss of death.
But I am hopeful that we can get a few things done… initiatives that can change policies and attitudes without a price tag or imposing unfunded mandates on schools and local governments.
Fortunately, schools and local governments are already getting in on the act.
According to the Express-News, San Antonio is beginning to see some of the changes spurred by $15.6 million in federal stimulus funds… a response to our status as one of the fattest cities in the nation.
Soon we'll see salad bars in schools, workout equipment in parks and libraries, the sale of more fresh fruits and vegetables in neighborhood stores and healthier restaurant menus. The city might even close some streets for a few hours at a time to allow for biking and strolling.
All in all, some 40 initiatives will benefit from this obesity grant.
Well, I think I've talked myself into talking a long walk. Thank you again for letting me visit with you today… and thank you for doing what you do. Each and every one of you is in a position to help individuals and families live fuller, healthier lives.